Healthcare Provider Details

I. General information

NPI: 1699746453
Provider Name (Legal Business Name): JACQUELYN A. HEDLUND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DRIVE SUITE 108
SCARBOROUGH ME
04074-9308
US

IV. Provider business mailing address

P.O. BOX 911
BRATTLEBORO VT
05302
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7600
  • Fax: 207-396-7986
Mailing address:
  • Phone: 207-396-7600
  • Fax: 207-396-7986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number13509
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number13509
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: