=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336234897
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL RICHARD EPSTEIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/20/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 417 STATE ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-6630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-973-8885
-----------------------------------------------------
Fax | 207-973-8817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 WHITING HILL RD STE 300
-----------------------------------------------------
City | BREWER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04412-1006
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | 016001
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------