Healthcare Provider Details

I. General information

NPI: 1619961919
Provider Name (Legal Business Name): DR. RANDY WOBSER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
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: 207-563-4700
  • Fax:
Mailing address:
  • Phone: 207-563-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77872
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD28663
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-07-7934-W
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: