Basic Information
| Provider Information | |||||||||
| NPI: | 1720192586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERNEL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | MCFADDEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 TROTTING TRACK RD | ||||||||
| Address2: | |||||||||
| City: | WOLFEBORO | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038944828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6033874555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LEWISTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 042407027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077950111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 01/04/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2239 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 9404 | NH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | RE 363402 | 01 | ME | MEDICARE PTAN: | OTHER |