Healthcare Provider Details

I. General information

NPI: 1659300515
Provider Name (Legal Business Name): DANIEL S OPPENHEIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

IV. Provider business mailing address

301 US ROUTE 1
SCARBOROUGH ME
04074-7609
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-7700
  • Fax: 207-885-7701
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD12692
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD12692
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: