Healthcare Provider Details

I. General information

NPI: 1730367285
Provider Name (Legal Business Name): MARK JENSEN, DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2239 ATLANTIC HWY
LINCOLNVILLE ME
04849-5310
US

IV. Provider business mailing address

2239 ATLANTIC HWY
LINCOLNVILLE ME
04849-5310
US

V. Phone/Fax

Practice location:
  • Phone: 207-236-0214
  • Fax: 207-230-1008
Mailing address:
  • Phone: 207-236-0214
  • Fax: 207-230-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1823
License Number StateME

VIII. Authorized Official

Name: DR. MARK JENSEN
Title or Position: DR.
Credential: DO
Phone: 207-236-0214