Healthcare Provider Details

I. General information

NPI: 1730256876
Provider Name (Legal Business Name): ERIC P OMSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325C KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

IV. Provider business mailing address

325C KENNEDY MEMORIAL DR
WATERVILLE ME
04901-4517
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-5859
  • Fax: 207-872-0840
Mailing address:
  • Phone: 207-872-5859
  • Fax: 207-872-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number013249
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: