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General NPI Number Information
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NPI Number | 1538248141
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Entity Type | Organization
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Legal Business Name | SUNBURY PRIMARY CARE, P.A.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 01/21/2009
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Provider Practice Location Address
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Address Line | 900 BROADWAY BUILDING 1
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City | BANGOR
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State | ME
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Zip | 04401-1900
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Country | US
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Telephone | 207-945-2616
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Fax | 207-945-2623
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Provider Business Mailing Address
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Address Line | PO BOX 921
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City | BANGOR
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State | ME
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Zip | 04402-0921
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Country | US
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Telephone | 207-990-0864
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Fax | 207-990-5586
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DAVID L SAVELL
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Credential |
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Telephone | 207-942-7650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | POD1028
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License Number State | ME
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