Healthcare Provider Details

I. General information

NPI: 1679784045
Provider Name (Legal Business Name): WISCASSET FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 WATER ST
WISCASSET ME
04578-4133
US

IV. Provider business mailing address

PO BOX 351 66 WATER STR
WISCASSET ME
04578-4133
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
Title or Position: SOLE MBR/PHYSICIAN
Credential: MD
Phone: 207-882-6008