Healthcare Provider Details

I. General information

NPI: 1740228485
Provider Name (Legal Business Name): WENDELL J BULMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 N MAIN ST
PITTSFIELD ME
04967-3707
US

IV. Provider business mailing address

447 N MAIN ST
PITTSFIELD ME
04967-3799
US

V. Phone/Fax

Practice location:
  • Phone: 207-487-5141
  • Fax: 207-487-4585
Mailing address:
  • Phone: 207-487-5141
  • Fax: 207-487-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS 7010
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDO2787
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: