Healthcare Provider Details

I. General information

NPI: 1649702382
Provider Name (Legal Business Name): LAURA GROOMES LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MEDICAL CENTER DR STE 2200
BRUNSWICK ME
04011-2765
US

IV. Provider business mailing address

81 MEDICAL CENTER DR
BRUNSWICK ME
04011-2764
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-8333
  • Fax: 207-618-5670
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO3042
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: