Healthcare Provider Details

I. General information

NPI: 1467453233
Provider Name (Legal Business Name): BLOCK & GRATWICK, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 UNION ST
BANGOR ME
04401-4606
US

IV. Provider business mailing address

275 UNION ST
BANGOR ME
04401-4606
US

V. Phone/Fax

Practice location:
  • Phone: 207-945-9442
  • Fax: 207-942-9515
Mailing address:
  • Phone: 207-945-9442
  • Fax: 207-942-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateME

VIII. Authorized Official

Name: SIDNEY R BLOCK
Title or Position: PRESIDENT
Credential: MD
Phone: 207-945-9442