Provider Demographics
NPI:1750348439
Name:VANDEINSE, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:VANDEINSE
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 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3747
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:9 HEATHCARE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3760
Practice Address - Country:US
Practice Address - Phone:207-283-1427
Practice Address - Fax:207-283-1429
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012056207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME298720099Medicaid
MEM20001801OtherCIGNA
MEA67530OtherHARVARD PILGRIM
ME1041712OtherAETNA
ME017219OtherANTHEM
A67530Medicare UPIN
MEMM0475Medicare ID - Type Unspecified
MEA67530OtherHARVARD PILGRIM