Healthcare Provider Details

I. General information

NPI: 1699860270
Provider Name (Legal Business Name): YORK HOSPITAL DBA COASTAL OB-GYN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 SANFORD ROAD SUITE 2A
WELLS ME
04090
US

IV. Provider business mailing address

PO BOX 810
WESTBROOK ME
04098
US

V. Phone/Fax

Practice location:
  • Phone: 207-641-8044
  • Fax: 207-641-8169
Mailing address:
  • Phone: 207-854-1544
  • Fax: 207-854-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN LABONTE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 207-351-2391