Healthcare Provider Details

I. General information

NPI: 1326229741
Provider Name (Legal Business Name): NANCY J. OLIPHANT MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 TOWNSEND AVE STE R
BOOTHBAY HARBOR ME
04538-1895
US

IV. Provider business mailing address

185 TOWNSEND AVE STE R
BOOTHBAY HARBOR ME
04538-1895
US

V. Phone/Fax

Practice location:
  • Phone: 207-633-1075
  • Fax: 207-633-1067
Mailing address:
  • Phone: 207-633-1075
  • Fax: 207-633-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014473
License Number StateME

VIII. Authorized Official

Name: DR. NANCY J OLIPHANT
Title or Position: PRESIDENT
Credential: MD
Phone: 207-633-1075