=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073194049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGNIFIED MEDICAL CARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2021
-----------------------------------------------------
Last Update Date | 11/10/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 69 MAIN ST STE 4
-----------------------------------------------------
City | ORONO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04473-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-962-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 69 MAIN ST STE 4
-----------------------------------------------------
City | ORONO
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04473-4087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-962-1200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. MEGHANN L. DEROSIER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 207-962-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------