MEDICARE: JULIE B. DARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD21561	ME

General Provider Information

NPI Number	:	1285046144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE B. DARK MD

Provider Business Mailing Address
First Line	:	100 GANNETT DR STE C
Second Line	:
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106-5900
Country	:	US
Telephone Number	:	207-347-2947
Fax Number	:	207-874-2317

Provider Business Practice Location Address
First Line	:	84 MARGINAL WAY
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2443
Country	:	US
Telephone Number	:	207-774-4092
Fax Number	:	207-523-8596

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2014
Last Update Date	:	04/06/2026

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