Healthcare Provider Details

I. General information

NPI: 1962443713
Provider Name (Legal Business Name): GLENN STEPHEN RAMPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 KELLEY RD
ORONO ME
04473-3416
US

IV. Provider business mailing address

43 WHITING HILL RD
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-866-4399
  • Fax: 207-866-4538
Mailing address:
  • Phone: 207-866-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012091
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: