Healthcare Provider Details

I. General information

NPI: 1073736229
Provider Name (Legal Business Name): ROLAND H. KNAUSENBERGER, M.D. PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 KENNEDY MEMORIAL DR SUITE 202
WATERVILLE ME
04901-4540
US

IV. Provider business mailing address

180 KENNEDY MEMORIAL DR SUITE 202
WATERVILLE ME
04901-4540
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-2900
  • Fax: 207-872-8495
Mailing address:
  • Phone: 207-872-2900
  • Fax: 207-872-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number014248
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number014248
License Number StateME

VIII. Authorized Official

Name: ROLAND H KNAUSENBERGER
Title or Position: MD
Credential: MD
Phone: 207-872-2900