Healthcare Provider Details

I. General information

NPI: 1710957428
Provider Name (Legal Business Name): ISAAC MARTIN BROMBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GLEN COVE DR STE 101
ROCKPORT ME
04856-4235
US

IV. Provider business mailing address

4 GLEN COVE DR STE 101
ROCKPORT ME
04856-4235
US

V. Phone/Fax

Practice location:
  • Phone: 207-301-3090
  • Fax: 207-301-5295
Mailing address:
  • Phone: 207-301-3090
  • Fax: 207-301-5295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License NumberMD30570
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD30570
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number94397
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number223813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: