Healthcare Provider Details

I. General information

NPI: 1558336131
Provider Name (Legal Business Name): JAY MORRIS UNGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 MARQUIS RD SOUTHERN MAINE GERIATRICS ASSOCIATES LLC
FREEPORT ME
04032-6477
US

IV. Provider business mailing address

50 MARQUIS RD SOUTHERN MAINE GERIATRICS ASSOCIATES LLC
FREEPORT ME
04032-6477
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-6131
  • Fax: 207-865-9399
Mailing address:
  • Phone: 207-865-6131
  • Fax: 207-865-9399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19931
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number40904
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD19931
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: