Healthcare Provider Details

I. General information

NPI: 1639343429
Provider Name (Legal Business Name): MAINE BONE & JOINT SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 FIRST PARK DRIVE
OAKLAND ME
04963
US

IV. Provider business mailing address

107 FIRST PARK DRIVE
OAKLAND ME
04963
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-8100
  • Fax: 207-873-8101
Mailing address:
  • Phone: 207-873-8100
  • Fax: 207-873-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MARC S GOLDEN
Title or Position: MEMBER
Credential: DO
Phone: 207-873-0200