Healthcare Provider Details

I. General information

NPI: 1932140019
Provider Name (Legal Business Name): EVA M ENZINGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 CENTRAL AVE STE L CENTRAL COMMONS
DOVER NH
03820-3434
US

IV. Provider business mailing address

5 BARTER CREEK ROAD
KITTERY ME
03905-5611
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-7001
  • Fax: 207-439-4793
Mailing address:
  • Phone: 207-992-7001
  • Fax: 207-439-4793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11732
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015882
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: