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NPI Code Detail

MEDICARE: DR. TIMOTHY F PRUCHNIC MD

MEDICARE: DR. TIMOTHY F PRUCHNIC 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
1204F00000XTransplant Surgery PhysicianME0093552FL
2207Q00000XFamily Medicine Physician44018KY
3207XS0106XOrthopaedic Hand Surgery PhysicianMD19592ME

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00974623OTHERKYRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2000000729969OTHERKYBCBS

General Provider Information

NPI Number : 1851392385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY F PRUCHNIC MD
Provider Business Mailing Address
First Line : 43 WHITING HILL RD
Second Line : SUITE 300
City : BREWER
State : ME
Zip : 04412-1005
Country : US
Telephone Number : 207-973-5035
Fax Number : 207-973-5042
Provider Business Practice Location Address
First Line : 489 STATE ST
Second Line :
City : BANGOR
State : ME
Zip : 04401-6616
Country : US
Telephone Number : 207-973-7000
Fax Number : 207-973-5042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 03/13/2013

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