Basic Information
| Provider Information | |||||||||
| NPI: | 1225010184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072829080 | ||||||||
| FaxNumber: | 2074678910 | ||||||||
| Practice Location | |||||||||
| Address1: | 72 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | KENNEBUNK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040437021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074678909 | ||||||||
| FaxNumber: | 2074678910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 02/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD19517 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207RR0500X | MD19517 | ME | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207Q00000X | MD19517 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1225010184 | 01 | ME | ANTHEM | OTHER | 845433 | 01 | ME | AETNA | OTHER | 1225010184 | 05 | ME | MEDICAID |