Healthcare Provider Details

I. General information

NPI: 1386727782
Provider Name (Legal Business Name): WHITNEY JAMES MCBRIDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST
BANGOR ME
04401-6630
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8853
  • Fax: 207-973-9003
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD21509
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: