Provider Demographics
NPI:1740331008
Name:FALMOUTH INTERNAL MEDICINE PA
Entity type:Organization
Organization Name:FALMOUTH INTERNAL MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-781-7778
Mailing Address - Street 1:170 US ROUTE 1
Mailing Address - Street 2:SUITE G
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2137
Mailing Address - Country:US
Mailing Address - Phone:207-781-7778
Mailing Address - Fax:207-781-7779
Practice Address - Street 1:170 US ROUTE 1
Practice Address - Street 2:SUITE G
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2137
Practice Address - Country:US
Practice Address - Phone:207-781-7778
Practice Address - Fax:207-781-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME402700000Medicaid
ME01Z017045ME02OtherANTHEM
MEME0483Medicare PIN
ME01Z017045ME02OtherANTHEM