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General NPI Number Information
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NPI Number | 1083727606
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Entity Type | Individual
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Provider Name | WILLIAM DEAN JEANBLANC MD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2816
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Fax | 207-662-6783
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Provider Business Mailing Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-2816
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Fax | 207-662-6783
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD16127
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | MD16127
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License Number State | ME
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