Healthcare Provider Details

I. General information

NPI: 1679928618
Provider Name (Legal Business Name): JARROD TEMBREULL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

IV. Provider business mailing address

24 MILES CENTER WAY
DAMARISCOTTA ME
04543-4067
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-4250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberMD23688
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD23688
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberMD23688
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD23688
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: