Healthcare Provider Details

I. General information

NPI: 1871515379
Provider Name (Legal Business Name): STEPHEN IRA ESKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY STE 100
BANGOR ME
04401-3900
US

IV. Provider business mailing address

PO BOX 347544
CORAL GABLES FL
33234-7544
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-3550
  • Fax: 207-907-3562
Mailing address:
  • Phone: 305-447-6987
  • Fax: 305-447-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME93038
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD21763
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: