Healthcare Provider Details

I. General information

NPI: 1124483433
Provider Name (Legal Business Name): NORTH WOODS GENERAL PRACTICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MAIN ST
SHERMAN ME
04776-3064
US

IV. Provider business mailing address

226 MAIN ST
SHERMAN ME
04776-3064
US

V. Phone/Fax

Practice location:
  • Phone: 207-365-4335
  • Fax:
Mailing address:
  • Phone: 207-365-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD11485
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1124483433
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 2
IdentifierDW4747
Identifier TypeOTHER
Identifier StateME
Identifier IssuerRAILROAD MEDICARE
# 3
Identifier7172979
Identifier TypeOTHER
Identifier State
Identifier IssuerCIGNA

VIII. Authorized Official

Name: MARTIN J HRYNICK
Title or Position: OWNER
Credential:
Phone: 207-365-4335