Basic Information
Provider Information | |||||||||
NPI: | 1639183718 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CVITKOVICH | ||||||||
FirstName: | DONALD | ||||||||
MiddleName: | G | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12 HOSPITAL DR | ||||||||
Address2: | SUITE C | ||||||||
City: | YORK | ||||||||
State: | ME | ||||||||
PostalCode: | 039091030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2073513715 | ||||||||
FaxNumber: | 2073513716 | ||||||||
Practice Location | |||||||||
Address1: | 12 HOSPITAL DR | ||||||||
Address2: | SUITE C | ||||||||
City: | YORK | ||||||||
State: | ME | ||||||||
PostalCode: | 039091030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2073513715 | ||||||||
FaxNumber: | 2073513716 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2006 | ||||||||
LastUpdateDate: | 12/02/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 015930 | ME | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RP1001X | 51173-20 | WI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
ID | Type | State | Issuer | Description | 041670 | 01 | ME | BC/BS | OTHER | 01Y004052ME01 | 01 | ME | NH BC/BS | OTHER | 753075422 | 01 |   | MILITARY HEALTH | OTHER | 2885154 | 01 |   | AETNA | OTHER | M21490 | 01 |   | CIGNA HEATHSOURCE | OTHER | 189500000 | 05 | ME |   | MEDICAID | 2233094 | 01 |   | CIGNA | OTHER | D95576 | 01 |   | HARVARD PILGRIM | OTHER |