Healthcare Provider Details

I. General information

NPI: 1619949526
Provider Name (Legal Business Name): HENRY C. SKINNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 LISBON ST
LEWISTON ME
04240-5025
US

IV. Provider business mailing address

253 MAIN ST
YARMOUTH ME
04096-6800
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-9141
  • Fax: 207-376-3808
Mailing address:
  • Phone: 207-650-1393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number222511
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number222511
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD18501
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: