Provider Demographics
NPI:1770742439
Name:HASKELL, ERIC S (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:HASKELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:155 SPURWINK AVE
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-9604
Practice Address - Country:US
Practice Address - Phone:207-767-2174
Practice Address - Fax:207-767-1348
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME2223207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30228933Medicaid
ME002243101Medicare PIN
NH30228933Medicaid
MEP00990376Medicare PIN
ME002243102Medicare PIN