Provider Demographics
NPI:1811931249
Name:LODATO, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LODATO
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 1:41 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1311
Mailing Address - Country:US
Mailing Address - Phone:207-924-5226
Mailing Address - Fax:207-924-5992
Practice Address - Street 1:41 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1311
Practice Address - Country:US
Practice Address - Phone:207-924-5226
Practice Address - Fax:207-924-5992
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME13692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP00168957OtherRAILROAD MEDICARE
ME303810099Medicaid
ME303810099Medicaid
F48001Medicare UPIN