Active NPI
John Marley Dickens, MD
- General Practice Physician
- Waldoboro, ME
National Provider Identifier
1437159233
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 11529
- Practice address
- 592 W Main St
Waldoboro, ME 04572-6030 - Phone
- (207) 832-6394
- Fax
- (207) 832-4392
- NPI assigned
- Jul 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 11529 | ME | Primary |
Addresses
Primary practice location
592 W Main St
Waldoboro, ME 04572-6030
Mailing address
PO Box 680
Waldoboro, ME 04572-0680
Phone (207) 832-6394
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 310640099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11529 | ME | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1437159233",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 680",
"city": "WALDOBORO",
"state": "ME",
"postal_code": "045720680",
"telephone_number": "207-832-6394",
"fax_number": "207-832-4392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "592 W MAIN ST",
"city": "WALDOBORO",
"state": "ME",
"postal_code": "045726030",
"telephone_number": "207-832-6394",
"fax_number": "207-832-4392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKENS",
"first_name": "JOHN",
"middle_name": "MARLEY",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-22",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "ME",
"license": "11529",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "310640099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waldoboro, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.