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General NPI Number Information
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NPI Number | 1033446661
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Entity Type | Organization
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Legal Business Name | MIDCOAST EYE ASSOCIATES, P.A.
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Dates
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Enumeration Date | 11/03/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 130 CENTRE ST
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City | BATH
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State | ME
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Zip | 04530-2599
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Country | US
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Telephone | 207-443-6626
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Fax | 207-443-8142
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Provider Business Mailing Address
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Address Line | 130 CENTRE ST
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City | BATH
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State | ME
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Zip | 04530-2599
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Country | US
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Telephone | 207-443-6626
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Fax | 207-443-8142
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY GEORGE GENSHEIMER
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Credential | M.D.
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Telephone | 207-443-6626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 010700
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License Number State | ME
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