Healthcare Provider Details

I. General information

NPI: 1073676425
Provider Name (Legal Business Name): OCEANSIDE MEDICAL,PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 12/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 NORTHPORT AVE SUITE 212
BELFAST ME
04915-6095
US

IV. Provider business mailing address

116 NORTHPORT AVE SUITE 212
BELFAST ME
04915-6095
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-9968
  • Fax: 207-338-0332
Mailing address:
  • Phone: 207-338-9968
  • Fax: 207-338-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number013771
License Number StateME

VIII. Authorized Official

Name: DR. ROBERT DANIEL WEISS
Title or Position: PRESIDENT
Credential: MD
Phone: 207-338-9968