Healthcare Provider Details

I. General information

NPI: 1841290376
Provider Name (Legal Business Name): SIDNEY ROBERT BLOCK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/16/2008
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: 207-942-5915
Mailing address:
  • Phone: 207-945-9442
  • Fax: 207-942-5915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number008060
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: