Healthcare Provider Details

I. General information

NPI: 1578623625
Provider Name (Legal Business Name): KENNEBEC MEDICAL ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RAILROAD SQ
WATERVILLE ME
04901-6139
US

IV. Provider business mailing address

13 RAILROAD SQ
WATERVILLE ME
04901-6139
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-6869
  • Fax: 207-872-7910
Mailing address:
  • Phone: 207-872-6869
  • Fax: 207-872-7910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS DONNA R BILODEAU
Title or Position: SHAREHOLDER
Credential: F.N.P.
Phone: 207-872-6869