Healthcare Provider Details

I. General information

NPI: 1194795799
Provider Name (Legal Business Name): MARK A KANDUTSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 MAIN ST
BAR HARBOR ME
04609-1648
US

IV. Provider business mailing address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

V. Phone/Fax

Practice location:
  • Phone: 207-288-5081
  • Fax: 207-288-8449
Mailing address:
  • Phone: 207-288-5081
  • Fax: 207-288-8449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD10687
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: