Healthcare Provider Details

I. General information

NPI: 1124008784
Provider Name (Legal Business Name): PETER R HARBAGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 09/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST SUITE 1
NORWAY ME
04268-5645
US

IV. Provider business mailing address

193 MAIN ST SUITE 1
NORWAY ME
04268-5645
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7721
  • Fax: 207-743-6306
Mailing address:
  • Phone: 207-743-7721
  • Fax: 207-743-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD11984
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: