Provider Demographics
NPI:1447254115
Name:PYNE, JOHN I (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:I
Last Name:PYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:78 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-947-8381
Mailing Address - Fax:207-947-6056
Practice Address - Street 1:78 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-947-8381
Practice Address - Fax:207-947-6056
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013747207X00000X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000028936OtherRR MEDICARE
ME0560OtherHP
09-01065OtherUNITED HC
M67422OtherCIGNA
011499OtherANTHEM
1040724OtherAETNA
ME304280099Medicaid
ME304280099Medicaid
2000028936OtherRR MEDICARE