Healthcare Provider Details

I. General information

NPI: 1235553413
Provider Name (Legal Business Name): MOUNT DESERT ISLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 11/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMUNITY LANE
SOUTHWEST HARBOR ME
04679
US

IV. Provider business mailing address

PO BOX 731
SOUTHWEST HARBOR ME
04679-0731
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-2888
  • Fax: 207-244-0490
Mailing address:
  • Phone: 207-244-2888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JEAN ABBOTT
Title or Position: DIR. MEDICAL STAFF SUPPORT & QUALIT
Credential: RHIT
Phone: 207-288-5081