Basic Information
| Provider Information | |||||||||
| NPI: | 1871559203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRESTON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 247 | ||||||||
| Address2: | |||||||||
| City: | NORTH VASSALBORO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049620247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078731098 | ||||||||
| FaxNumber: | 2078735461 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 GARLAND RD | ||||||||
| Address2: | |||||||||
| City: | WINSLOW | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049010600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078731098 | ||||||||
| FaxNumber: | 2078615461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 05/05/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 012727 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | E05192 | 01 | HARVARD PILGRIM HEALTH | OTHER | 1100094189 | 01 | RAILROAD MEDICARE | OTHER | 004000 | 01 | ME | ANTHEM OF MAINE | OTHER | 5129623 | 01 | AETNA NON-HMO | OTHER | 1042587 | 01 | AETNA HMO | OTHER | 270150099 | 05 | ME | MEDICAID |