Healthcare Provider Details

I. General information

NPI: 1952387805
Provider Name (Legal Business Name): ELISABETH M. DELPRETE D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SHAPE DRIVE
KENNEBUNK ME
04043
US

IV. Provider business mailing address

1 MEDICAL CENTER DR PO BOX 626
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax: 207-467-8969
Mailing address:
  • Phone: 207-282-9080
  • Fax: 207-467-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1389
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: