Provider Demographics
NPI:1811963929
Name:COLT, HENRY F (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:F
Last Name:COLT
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 1:149 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4974
Mailing Address - Country:US
Mailing Address - Phone:207-861-5000
Mailing Address - Fax:207-861-5001
Practice Address - Street 1:149 NORTH ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4974
Practice Address - Country:US
Practice Address - Phone:207-861-5000
Practice Address - Fax:207-861-5001
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014004207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME271380099Medicaid
MEMM5700Medicare PIN
MEBX8422Medicare PIN
ME271380099Medicaid
ME080104569Medicare PIN