Healthcare Provider Details

I. General information

NPI: 1396848297
Provider Name (Legal Business Name): MEDOMAK FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/21/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 MAIN ST
WALDOBORO ME
04572-6037
US

IV. Provider business mailing address

PO BOX 309
WALDOBORO ME
04572-0309
US

V. Phone/Fax

Practice location:
  • Phone: 207-832-5813
  • Fax: 207-832-3070
Mailing address:
  • Phone: 207-832-5813
  • Fax: 207-832-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARGARET H WEBB
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 207-832-5813