Healthcare Provider Details

I. General information

NPI: 1003027509
Provider Name (Legal Business Name): AMANDA GAIL QUERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST WEBBER WEST, SUITE 141
BANGOR ME
04401-6630
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-4670
  • Fax: 207-973-4669
Mailing address:
  • Phone: 207-973-4670
  • Fax: 207-973-4669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDO2631
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDO2631
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: