Healthcare Provider Details

I. General information

NPI: 1003885708
Provider Name (Legal Business Name): HEINRICH H.M. GRUBE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PARKWAY, SUITE 101
AUGUSTA ME
04330
US

IV. Provider business mailing address

301C US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-430-4321
  • Fax: 207-430-4320
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD15990
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: