Healthcare Provider Details

I. General information

NPI: 1831189596
Provider Name (Legal Business Name): ROBERT M WHITEHOUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST
BANGOR ME
04401-6630
US

IV. Provider business mailing address

417 STATE ST
BANGOR ME
04401-6638
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8833
  • Fax: 207-973-8836
Mailing address:
  • Phone: 207-973-8833
  • Fax: 207-973-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number016759
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: