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General NPI Number Information
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NPI Number | 1568674232
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Entity Type | Organization
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Legal Business Name | WHITING BAY FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 125 US ROUTE 1
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City | WHITING
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State | ME
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Zip | 04691
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Country | US
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Telephone | 207-733-2900
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Fax | 207-733-2866
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Provider Business Mailing Address
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Address Line | PO BOX 108
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City | WHITING
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State | ME
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Zip | 04691-0108
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Country | US
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Telephone | 207-733-2900
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Fax | 207-733-2866
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | PAT A. GODIN
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Credential |
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Telephone | 207-733-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 013026
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License Number State | ME
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