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General NPI Number Information
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NPI Number | 1134579519
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Entity Type | Individual
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Provider Name | BO PANG DO
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Gender | Female
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 81 MEDICAL CENTER DR STE 1150
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City | BRUNSWICK
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State | ME
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Zip | 04011-2765
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Country | US
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Telephone | 207-721-0911
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Fax | 207-721-9729
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Provider Business Mailing Address
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Address Line | 81 MEDICAL CENTER DR STE 1150
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City | BRUNSWICK
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State | ME
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Zip | 04011-2765
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Country | US
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Telephone | 207-721-0911
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Fax | 207-721-9729
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | DO3270
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | 5101022329
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | DO3270
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License Number State | ME
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