Healthcare Provider Details

I. General information

NPI: 1043002066
Provider Name (Legal Business Name): OSTEOPATHIC MEDICINE OF MAINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 FARMINGTON FALLS RD
FARMINGTON ME
04938-6438
US

IV. Provider business mailing address

496 FARMINGTON FALLS RD
FARMINGTON ME
04938-6438
US

V. Phone/Fax

Practice location:
  • Phone: 207-212-1449
  • Fax:
Mailing address:
  • Phone: 207-212-1449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENNA MARTINI
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 207-392-5677