Healthcare Provider Details

I. General information

NPI: 1518161082
Provider Name (Legal Business Name): JARED LENZ D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 STATE HOSPITAL DR
BANGOR ME
04401
US

IV. Provider business mailing address

66 GRANDVIEW DR
NEWPORT ME
04953-3748
US

V. Phone/Fax

Practice location:
  • Phone: 207-561-3651
  • Fax: 207-947-1862
Mailing address:
  • Phone: 207-355-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO-1234
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO-1234
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: