Provider Demographics
NPI:1043346638
Name:CHENEY, PRESCOTT J (MD)
Entity type:Individual
Prefix:
First Name:PRESCOTT
Middle Name:J
Last Name:CHENEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 JOHN'S RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEMAQUID HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04558
Mailing Address - Country:US
Mailing Address - Phone:207-677-2158
Mailing Address - Fax:
Practice Address - Street 1:10 JOHN'S RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:PEMAQUID HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04558
Practice Address - Country:US
Practice Address - Phone:207-677-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA30390207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery