Basic Information
| Provider Information | |||||||||
| NPI: | 1740263433 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ENDERS | ||||||||
| FirstName: | VILLI | ||||||||
| MiddleName: | PETERS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 810 | ||||||||
| Address2: | |||||||||
| City: | WESTBROOK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040980810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078541544 | ||||||||
| FaxNumber: | 2078541516 | ||||||||
| Practice Location | |||||||||
| Address1: | 53 SEWALL ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041022625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078282020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 03/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 012829 | ME | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 147526-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | MD-052485-L | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 218470000 | 05 | ME | MEDICAID | 1740263433 | 01 | ME | INDIVIDUAL NPI | OTHER | 006187 | 01 | ME | ANTHEM OF MAINE | OTHER |