Healthcare Provider Details

I. General information

NPI: 1205356581
Provider Name (Legal Business Name): KYLE AARON BRONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 MAIN ST
SPRINGVALE ME
04083-1409
US

IV. Provider business mailing address

474 MAIN ST
SPRINGVALE ME
04083-1409
US

V. Phone/Fax

Practice location:
  • Phone: 844-292-0111
  • Fax: 207-490-5263
Mailing address:
  • Phone: 844-292-0111
  • Fax: 207-490-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number51301
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD30144
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: