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General NPI Number Information
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NPI Number | 1164698569
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Entity Type | Individual
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Provider Name | PIP HIDESTRAND M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 417 STATE ST STE 305
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City | BANGOR
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State | ME
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Zip | 04401-6654
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Country | US
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Telephone | 207-973-8585
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Fax | 207-973-8817
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Provider Business Mailing Address
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Address Line | 43 WHITING HILL RD STE 300
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City | BREWER
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State | ME
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Zip | 04412-1006
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Country | US
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Telephone | 207-973-8885
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Fax | 207-973-8817
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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 | 2080P0202X
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Taxonomy Name | Pediatric Cardiology Physician
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License Number | MD20555
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License Number State | ME
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