Healthcare Provider Details

I. General information

NPI: 1518155969
Provider Name (Legal Business Name): PAUL J BALZER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 PINELAND DR SUITE 302A
NEW GLOUCESTER ME
04260-5119
US

IV. Provider business mailing address

49 PINELAND DR SUITE 302A
NEW GLOUCESTER ME
04260-5119
US

V. Phone/Fax

Practice location:
  • Phone: 207-681-8100
  • Fax: 207-681-8102
Mailing address:
  • Phone: 207-681-8100
  • Fax: 207-681-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL J BALZER
Title or Position: OWNER PROVIDER
Credential: MD
Phone: 207-681-8100