Ian Noel Tadeo Don Don S Panuncialman, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD20887 Issued in ME

Practice address

234 State St
Brewer, ME 04412-1519

Phone

(207) 989-0550

Fax

(207) 989-0551

NPI assigned

Dec 6, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eastern Maine Medical Center

  • General Acute Care Hospital
  • Bangor, ME
  • NPI 1790789147
  Medicare reassignment NPD
• Eastern Maine Medical Center

  • Rehabilitation Hospital Unit
  • Bangor, ME
  • NPI 1780674689
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462752000000",
    "number": "1013190545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WHITING HILL RD",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121005",
            "telephone_number": "207-989-0550",
            "fax_number": "207-989-0551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 STATE ST",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044121519",
            "telephone_number": "207-989-0550",
            "fax_number": "207-989-0551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANUNCIALMAN",
        "first_name": "IAN NOEL TADEO DON",
        "middle_name": "DON S",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-06",
        "last_updated": "2016-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MA",
            "license": "233959",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ME",
            "license": "MD20887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linda M Orlando, LCPC
• William Glenn Osgood, CADC
• Christopher D Ouellette, DPT, ATC
• Karrie Ann Ouellette, FNP-C
• Lincoln Pan, LCSW
• Ravi Sankar Pappu
• Jason Douglas Paradis
• Sheila Karina Velasco Pascual, MD
• Yelena Patsiornik, MD
• Peak Performance Physical Therapy, LLC

• Family Medicine Physician in Brewer, ME
• Providers in Brewer, ME by specialty
• Family Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.