Healthcare Provider Details

I. General information

NPI: 1518064047
Provider Name (Legal Business Name): MOUNT DESERT ISLAND HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMUNITY LANE
SOUTHWEST HARBOR ME
04679-4273
US

IV. Provider business mailing address

10 WAYMAN LN
BAR HARBOR ME
04609-1625
US

V. Phone/Fax

Practice location:
  • Phone: 207-244-2888
  • Fax: 207-244-0490
Mailing address:
  • Phone: 207-288-5082
  • Fax: 207-288-8620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1347980001
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JEAN ABBOTT
Title or Position: DIRECTOR OF MEDICAL STAFF SUPPORT
Credential:
Phone: 207-288-5081