Provider Demographics
NPI:1548320971
Name:STITZELL, WILLARD (DO)
Entity type:Individual
Prefix:
First Name:WILLARD
Middle Name:
Last Name:STITZELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:SEBAGO
Mailing Address - State:ME
Mailing Address - Zip Code:04029-0249
Mailing Address - Country:US
Mailing Address - Phone:207-571-8585
Mailing Address - Fax:207-513-1069
Practice Address - Street 1:680 HANCOCK POND RD
Practice Address - Street 2:
Practice Address - City:SEBAGO
Practice Address - State:ME
Practice Address - Zip Code:04029-3015
Practice Address - Country:US
Practice Address - Phone:207-571-8585
Practice Address - Fax:207-513-1069
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1148207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010847OtherANTHEM
E47521OtherHARVARD PILGRIM HEALTHCAR
ME166850099Medicaid
NH20001672Medicaid
ME010847OtherANTHEM
MEE47521Medicare UPIN
NH20001672Medicaid