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General NPI Number Information
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NPI Number | 1043374044
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Entity Type | Organization
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Legal Business Name | MOUSAM VALLEY ORTHOPAEDICS PA
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 01/28/2008
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Provider Practice Location Address
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Address Line | 312 COTTAGE ST
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City | SANFORD
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State | ME
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Zip | 04073-1828
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Country | US
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Telephone | 207-324-1488
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Fax | 207-490-5733
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Provider Business Mailing Address
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Address Line | 312 COTTAGE ST
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City | SANFORD
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State | ME
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Zip | 04073-1828
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Country | US
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Telephone | 207-324-1488
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Fax | 207-490-5733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RANDI D LEBAR
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Credential | M.D.
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Telephone | 207-324-1488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | ME
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