Healthcare Provider Details

I. General information

NPI: 1740281625
Provider Name (Legal Business Name): DONALD P ENDRIZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 05/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BUCKNAM RD SUITE 1D
FALMOUTH ME
04105-1392
US

IV. Provider business mailing address

301C US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-1551
  • Fax: 207-781-1552
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD12325
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: