Healthcare Provider Details

I. General information

NPI: 1285867044
Provider Name (Legal Business Name): EDWARD B KITFIELD III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WATER STREET
WISCASSET ME
04578
US

IV. Provider business mailing address

PO BOX 351
WISCASSET ME
04578-0351
US

V. Phone/Fax

Practice location:
  • Phone: 207-882-6008
  • Fax: 207-882-7803
Mailing address:
  • Phone: 207-882-6008
  • Fax: 207-882-7803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number008477
License Number StateME

VIII. Authorized Official

Name: EDWARD B. KITFIELD III
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 207-882-6008