Basic Information
| Provider Information | |||||||||
| NPI: | 1881799278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SACCHETTI | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | J | ||||||||
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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 | ||||||||
| TelephoneNumber: | 2072829080 | ||||||||
| FaxNumber: | 2074678910 | ||||||||
| Practice Location | |||||||||
| Address1: | 72 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | KENNEBUNK | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074678909 | ||||||||
| FaxNumber: | 2074678910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 09/04/2014 | ||||||||
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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 | 229934 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | MD17471 | ME | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00429115 | 01 | ME | RR MEDICARE | OTHER | 099771 | 01 | ME | ANTHEM ME | OTHER | 1595882 | 01 | ME | AETNA HMO | OTHER | 6425922 | 01 | CIGNA | OTHER | 432608199 | 05 | ME | MEDICAID |