Healthcare Provider Details

I. General information

NPI: 1225057565
Provider Name (Legal Business Name): JILL CHARLOTTE DIMARTINIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SANFORD RD
WELLS ME
04090-5533
US

IV. Provider business mailing address

51 US ROUTE 1 STE A
SCARBOROUGH ME
04074-7145
US

V. Phone/Fax

Practice location:
  • Phone: 207-646-5211
  • Fax: 207-641-8151
Mailing address:
  • Phone: 207-396-1440
  • Fax: 207-289-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD17055
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: