Healthcare Provider Details

I. General information

NPI: 1720340698
Provider Name (Legal Business Name): JESSICA BELL DO PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 07/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOWDOIN MILL IS SUITE 202
TOPSHAM ME
04086-1265
US

IV. Provider business mailing address

1 BOWDOIN MILL IS SUITE 202
TOPSHAM ME
04086-1265
US

V. Phone/Fax

Practice location:
  • Phone: 207-841-8900
  • Fax: 207-725-7549
Mailing address:
  • Phone: 207-841-8900
  • Fax: 207-725-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number2102
License Number StateME

VIII. Authorized Official

Name: JESSICA D BELL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 207-841-8900