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General NPI Number Information
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NPI Number | 1043281959
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Entity Type | Individual
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Provider Name | SUSAN MIESFELDT MD
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Gender | Female
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 100 CAMPUS DRIVE SUITE 110
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City | SCARBOROUGH
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State | ME
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Zip | 04074
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Country | US
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Telephone | 207-396-7678
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Fax | 207-396-8766
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | MD16381
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License Number State | ME
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