Healthcare Provider Details

I. General information

NPI: 1790415875
Provider Name (Legal Business Name): CRYSTAL DAIGLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NORTH ST STE 1
PRESQUE ISLE ME
04769-2295
US

IV. Provider business mailing address

23 NORTH ST STE 1
PRESQUE ISLE ME
04769-2295
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-5437
  • Fax: 207-764-4760
Mailing address:
  • Phone: 207-764-5437
  • Fax: 207-764-4760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29728
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: