Basic Information
| Provider Information | |||||||||
| NPI: | 1467476226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BUSH | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059422 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 46 BARRA RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | BIDDEFORD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040059461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2072831126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | MD17164 | ME | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207X00000X | MD17164 | ME | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | ME2088 | 01 | MEDICARE | OTHER | 100294000 | 01 | USPS WC | OTHER | AA67813 | 01 | HARVARD PILGRIM | OTHER | BU-ME2088 | 01 | CMS PROVIDER IDENTIFICATION NUMBER | OTHER | 128943 | 01 | AETNA | OTHER | 201017 | 01 | ASC FACILITY | OTHER | MM0716 | 01 | CLINIC FACILITY | OTHER | 010416156 | 01 | CORE / MEDNET / TRAVELERS | OTHER | 0378600001 | 01 | DMERC | OTHER | 432322499 | 01 | ME | MAINECARE | OTHER | 0526606 | 01 | CIGNA / GREAT WEST | OTHER | 100522 | 01 | ANTHEM | OTHER |