Provider Demographics
NPI:1740344902
Name:BILOTTI, EDWARD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:BILOTTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2278
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04116-2278
Mailing Address - Country:US
Mailing Address - Phone:908-240-3106
Mailing Address - Fax:207-747-5129
Practice Address - Street 1:16 ATLANTIC PL
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2316
Practice Address - Country:US
Practice Address - Phone:908-240-3106
Practice Address - Fax:207-747-5129
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD191902084P0800X
NJ25MA65783002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002752502Medicare PIN
NJG81155Medicare UPIN
NJ051640Medicare PIN
ME002752501Medicare PIN