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General NPI Number Information
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NPI Number | 1265418016
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Entity Type | Individual
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Provider Name | JENS ELDRUP-JORGENSEN MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 887 CONGRESS ST SUITE 400
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City | PORTLAND
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State | ME
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Zip | 04102-3100
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Country | US
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Telephone | 207-774-6368
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Fax | 207-774-9388
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD12526
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | MD12526
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License Number State | ME
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