Healthcare Provider Details

I. General information

NPI: 1972790483
Provider Name (Legal Business Name): IRIS SAVERNIK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST MEDICINE
ELLSWORTH ME
04605-1534
US

IV. Provider business mailing address

50 UNION ST MEDICINE
ELLSWORTH ME
04605-1534
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5314
  • Fax: 207-664-5373
Mailing address:
  • Phone: 207-664-5314
  • Fax: 207-664-5373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number2151
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2151
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2151
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: