Healthcare Provider Details

I. General information

NPI: 1639118458
Provider Name (Legal Business Name): JAMES EDWARD CHLEBOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 W MAIN ST
WALDOBORO ME
04572-6030
US

IV. Provider business mailing address

592 W MAIN ST
WALDOBORO ME
04572-6030
US

V. Phone/Fax

Practice location:
  • Phone: 207-832-6394
  • Fax: 207-832-4392
Mailing address:
  • Phone: 207-832-6394
  • Fax: 207-832-4392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD047550L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD27083
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: