Healthcare Provider Details

I. General information

NPI: 1073790184
Provider Name (Legal Business Name): JOSEPH M. CONSTANTINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HAMMOND ST
BANGOR ME
04401-4645
US

IV. Provider business mailing address

300 HAMMOND ST
BANGOR ME
04401-4645
US

V. Phone/Fax

Practice location:
  • Phone: 207-942-9301
  • Fax: 207-942-9301
Mailing address:
  • Phone: 207-942-9301
  • Fax: 207-942-9301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD135
License Number StateME

VIII. Authorized Official

Name: DEBORAH A. MCCANN
Title or Position: SECRETARY
Credential:
Phone: 207-942-9301