Basic Information
Provider Information | |||||||||
NPI: | 1134173370 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CADE | ||||||||
FirstName: | CRAIG | ||||||||
MiddleName: | B. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 140 ACADEMY ST | ||||||||
Address2: |   | ||||||||
City: | PRESQUE ISLE | ||||||||
State: | ME | ||||||||
PostalCode: | 047693180 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2077684100 | ||||||||
FaxNumber: | 2077684014 | ||||||||
Practice Location | |||||||||
Address1: | 390 BAR HARBOR RD | ||||||||
Address2: |   | ||||||||
City: | TRENTON | ||||||||
State: | ME | ||||||||
PostalCode: | 046055807 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2076675899 | ||||||||
FaxNumber: | 2078015123 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/20/2006 | ||||||||
LastUpdateDate: | 06/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/09/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | LT06020 | ME | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.