Healthcare Provider Details

I. General information

NPI: 1649616319
Provider Name (Legal Business Name): CLAUDIA WINOGRAD HEISE M.D. PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA WINOGRAD MD PHD

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MUSSEY RD STE 2
SCARBOROUGH ME
04074-9570
US

IV. Provider business mailing address

20 MUSSEY RD STE 2
SCARBOROUGH ME
04074-9570
US

V. Phone/Fax

Practice location:
  • Phone: 207-535-1880
  • Fax:
Mailing address:
  • Phone: 207-885-1333
  • Fax: 207-885-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD21296
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: