Provider Demographics
NPI:1932147667
Name:TINGUELY, GERALD PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:PETER
Last Name:TINGUELY
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 1:111 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6144
Mailing Address - Country:US
Mailing Address - Phone:207-778-6031
Mailing Address - Fax:207-779-2303
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-6031
Practice Address - Fax:207-779-2303
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000204013Medicaid
ME000204013Medicaid
MEB86640Medicare UPIN