Basic Information
| Provider Information | |||||||||
| NPI: | 1003805995 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITAKER | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| 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 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 015596 | ME | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 3739577 | 01 | ME | AETNA | OTHER | 061139 | 01 | ME | ANTHEM BLUE CROSS | OTHER | 325120099 | 05 | ME | MEDICAID | M2307901 | 01 | ME | CIGNA | OTHER | P00184354 | 01 | ME | RAILROAD MEDICARE | OTHER | 431545400 | 05 | ME | MEDICAID |