Healthcare Provider Details

I. General information

NPI: 1467683102
Provider Name (Legal Business Name): JENNIFER BETH GALVIN SALISBURY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 DOW RD
ORRINGTON ME
04474-3539
US

IV. Provider business mailing address

283 DOW RD
ORRINGTON ME
04474-3539
US

V. Phone/Fax

Practice location:
  • Phone: 207-300-3855
  • Fax:
Mailing address:
  • Phone: 508-930-5463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDO2406
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: