Ethan W Dispoto, ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT960 Issued in ME

Practice address

200 Sanford Rd
Wells, ME 04090-5534

Phone

(973) 600-3147

NPI assigned

Aug 12, 2025

Last updated

Aug 12, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1754956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754956800000",
    "number": "1316823776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88 BUENA VISTA DR",
            "city": "RINGWOOD",
            "state": "NJ",
            "postal_code": "074562028",
            "telephone_number": "973-600-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SANFORD RD",
            "city": "WELLS",
            "state": "ME",
            "postal_code": "040905534",
            "telephone_number": "973-600-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISPOTO",
        "first_name": "ETHAN",
        "middle_name": "W",
        "name_prefix": "Mr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-08-12",
        "last_updated": "2025-08-12",
        "certification_date": "2025-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ME",
            "license": "AT960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lillian Connelly
• Jeffrey T Cote, M.D.
• CVS State Capital, L.L.C. (CVS Pharmaacy #00959)
• David H. Upton, Inc
• Jill Charlotte Dimartinis, MD
• Patricia Endsley, RN
• Catherine Finch, RN
• Michael Finneran, PHARMD
• Erich A Fogg, PA-C
• Foot and Ankle Surgical Assoc

• Athletic Trainer in Wells, ME
• Providers in Wells, ME by specialty
• Athletic Trainer in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.