Provider Demographics
NPI:1952339178
Name:BANCROFT, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:BANCROFT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:301 US ROUTE 1
Mailing Address - Street 2:BUILDING C
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7609
Mailing Address - Country:US
Mailing Address - Phone:207-396-8600
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 410B
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-523-3289
Practice Address - Fax:207-761-8198
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-03
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Provider Licenses
StateLicense IDTaxonomies
ME0142002080P0206X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME330460099Medicaid
NH30009613Medicaid
NH30009613Medicaid
MEMM6286Medicare PIN