Healthcare Provider Details

I. General information

NPI: 1043281959
Provider Name (Legal Business Name): SUSAN MIESFELDT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CAMPUS DRIVE SUITE 110
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

301C US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7678
  • Fax: 207-396-8766
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD16381
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: