Provider Demographics
NPI:1437138955
Name:FAIRFIELD, WESLEY P (MD, ECNU)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:P
Last Name:FAIRFIELD
Suffix:
Gender:M
Credentials:MD, ECNU
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-7520
Mailing Address - Fax:207-795-7179
Practice Address - Street 1:144 STATE ST FL 4
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3776
Practice Address - Country:US
Practice Address - Phone:207-400-8500
Practice Address - Fax:207-400-8508
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015822207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG96618Medicare UPIN
MEMM9482Medicare ID - Type Unspecified