Healthcare Provider Details

I. General information

NPI: 1528089315
Provider Name (Legal Business Name): ERWIN B SEYWERD, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 ARSENAL ST
AUGUSTA ME
04330-5704
US

IV. Provider business mailing address

79 ARSENAL ST
AUGUSTA ME
04330-5704
US

V. Phone/Fax

Practice location:
  • Phone: 207-622-1445
  • Fax:
Mailing address:
  • Phone: 207-622-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number012487
License Number StateME

VIII. Authorized Official

Name: DR. ERWIN SEYWERD
Title or Position: PRESIDENT CEO
Credential: M.D.
Phone: 207-622-1445