Healthcare Provider Details

I. General information

NPI: 1700025624
Provider Name (Legal Business Name): ELLEN F LAUER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN F BURSCH DO

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 TELCOM DR
BANGOR ME
04401-3072
US

IV. Provider business mailing address

PO BOX 1599
BANGOR ME
04402-1599
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-2152
  • Fax: 207-992-2154
Mailing address:
  • Phone: 207-945-5247
  • Fax: 207-947-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO2254
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: