Active NPI
Andrew Lackoff, M.D.
- Hospitalist Physician
- Rockport, ME
National Provider Identifier
1558498915
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hospitalist Physician
- License
- MD11709
- Practice address
- 6 Glen Cove Dr
Rockport, ME 04856-4240 - Phone
- (207) 596-8000
- Fax
- (207) 593-5302
- NPI assigned
- Feb 27, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0117709 | ME | |
| Hospitalist Physician | 208M00000X | MD11709 | ME | Primary |
Addresses
Primary practice location
6 Glen Cove Dr
Rockport, ME 04856-4240
Mailing address
6 Glen Cove Dr
Rockport, ME 04856-4240
Phone (207) 596-8000
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 |
|---|---|---|---|
| 0117709 | ME | MD | Family Medicine Physician |
| MD11709 | ME | MD | Hospitalist Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386720000000",
"number": "1558498915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 GLEN COVE DR",
"city": "ROCKPORT",
"state": "ME",
"postal_code": "048564240",
"telephone_number": "207-596-8000",
"fax_number": "207-593-5302"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 GLEN COVE DR",
"city": "ROCKPORT",
"state": "ME",
"postal_code": "048564240",
"telephone_number": "207-596-8000",
"fax_number": "207-593-5302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LACKOFF",
"first_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2013-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "ME",
"license": "0117709",
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "",
"desc": "Hospitalist",
"state": "ME",
"license": "MD11709",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockport, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.