Healthcare Provider Details

I. General information

NPI: 1225533821
Provider Name (Legal Business Name): SARAH DEHAAN GRAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH DEHAAN HAKKENBERG MD

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/24/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7041
US

IV. Provider business mailing address

964 ALLEN POND RD
GREENE ME
04236-3702
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24493
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: