Provider Demographics
NPI:1053418426
Name:DEKAY, JOSEPH RODMAN DRAKE (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:RODMAN DRAKE
Last Name:DEKAY
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 89
Mailing Address - Street 2:4 SEBAGO ROAD
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041-0089
Mailing Address - Country:US
Mailing Address - Phone:207-625-4730
Mailing Address - Fax:207-625-4957
Practice Address - Street 1:4 SEBAGO ROAD
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041-0089
Practice Address - Country:US
Practice Address - Phone:207-625-4730
Practice Address - Fax:207-625-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME994207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002061OtherANTHEM
ME112190000Medicaid
ME4573273OtherCIGNA
MED93091OtherHARVARD PILGRIM
ME030295Medicare PIN
ME002061OtherANTHEM
D93091Medicare UPIN