Healthcare Provider Details

I. General information

NPI: 1538106679
Provider Name (Legal Business Name): JOSEPH T DEGRINNEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/12/2020
Certification Date: 04/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PROFESSIONAL DR
SCARBOROUGH ME
04074-8897
US

IV. Provider business mailing address

301 US ROUTE 1 BUILDING C
SCARBOROUGH ME
04074-7609
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-3491
  • Fax: 207-885-5587
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD14646
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD14646
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: