Healthcare Provider Details

I. General information

NPI: 1740486034
Provider Name (Legal Business Name): DENISE MARY ANDERSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GLEN COVE DR SUITE 202
ROCKPORT ME
04856-4235
US

IV. Provider business mailing address

4 GLEN COVE DR SUITE 202
ROCKPORT ME
04856-4235
US

V. Phone/Fax

Practice location:
  • Phone: 207-593-5800
  • Fax: 207-593-5322
Mailing address:
  • Phone: 207-593-5800
  • Fax: 207-593-5322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2001
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDO2001
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: