Healthcare Provider Details

I. General information

NPI: 1043832058
Provider Name (Legal Business Name): DANIEL ENRIQUE LOMELIN MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2020
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 COMMUNITY LN
SOUTHWEST HARBOR ME
04679-4273
US

IV. Provider business mailing address

PO BOX 8
BAR HARBOR ME
04609-0008
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-5630
  • Fax: 207-801-5802
Mailing address:
  • Phone: 207-288-5802
  • Fax: 207-288-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35702
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27339
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: