Healthcare Provider Details

I. General information

NPI: 1568420453
Provider Name (Legal Business Name): BARBARA B HEUBLEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 NORTHPORT AVE
BELFAST ME
04915-6003
US

IV. Provider business mailing address

PO BOX 416
BELFAST ME
04915-0416
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-9926
  • Fax: 207-338-9227
Mailing address:
  • Phone: 207-338-9926
  • Fax: 207-338-9227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number014452
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: