Healthcare Provider Details

I. General information

NPI: 1720089626
Provider Name (Legal Business Name): DENNIS DESILVEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/21/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 WATER ST
BLUE HILL ME
04614
US

IV. Provider business mailing address

57 WATER ST
BLUE HILL ME
04614-5231
US

V. Phone/Fax

Practice location:
  • Phone: 207-374-3942
  • Fax: 207-374-3979
Mailing address:
  • Phone: 207-374-3930
  • Fax: 207-374-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD17042
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: