Healthcare Provider Details

I. General information

NPI: 1215107651
Provider Name (Legal Business Name): MR. MARK B. VAIL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HEMLOCK DR
SACO ME
04072-2453
US

IV. Provider business mailing address

PO BOX 229
SACO ME
04072-0229
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-9600
  • Fax:
Mailing address:
  • Phone: 207-284-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberDL-160
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: