Provider Demographics
NPI:1841290376
Name:BLOCK, SIDNEY ROBERT (MD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:ROBERT
Last Name:BLOCK
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 1:275 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4606
Mailing Address - Country:US
Mailing Address - Phone:207-945-9442
Mailing Address - Fax:207-942-5915
Practice Address - Street 1:275 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4606
Practice Address - Country:US
Practice Address - Phone:207-945-9442
Practice Address - Fax:207-942-5915
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008060207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312020099Medicaid
ME312020099Medicaid
ME012866Medicare ID - Type Unspecified