Basic Information
Provider Information
NPI: 1003805995
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITAKER
FirstName: MARTIN
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 193 MAIN ST
Address2:  
City: NORWAY
State: ME
PostalCode: 042685645
CountryCode: US
TelephoneNumber: 2077430027
FaxNumber: 2077430051
Practice Location
Address1: 193 MAIN ST
Address2:  
City: NORWAY
State: ME
PostalCode: 042685645
CountryCode: US
TelephoneNumber: 2077430027
FaxNumber: 2077430051
Other Information
ProviderEnumerationDate: 10/14/2005
LastUpdateDate: 08/28/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X015596MEY Allopathic & Osteopathic PhysiciansOphthalmology 

ID Information
IDTypeStateIssuerDescription
P0018435401MERAILROAD MEDICAREOTHER
06113901MEANTHEM BLUE CROSSOTHER
373957701MEAETNAOTHER
M230790101MECIGNAOTHER
32512009905ME MEDICAID
43154540005ME MEDICAID


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