Healthcare Provider Details

I. General information

NPI: 1124260831
Provider Name (Legal Business Name): VILLI P ENDERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SEWALL ST
PORTLAND ME
04102-2625
US

IV. Provider business mailing address

PO BOX 810
WESTBROOK ME
04098-0810
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2020
  • Fax:
Mailing address:
  • Phone: 207-854-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number012829
License Number StateME

VIII. Authorized Official

Name: VILLI ENDERS
Title or Position: OWNER
Credential: MD
Phone: 207-828-2020