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General NPI Number Information
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NPI Number | 1598735722
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Entity Type | Individual
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Provider Name | MARY E DUDZIK MD
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 08/04/2023
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Provider Practice Location Address
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Address Line | 735 WILSON ST
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City | BREWER
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State | ME
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Zip | 04412-1000
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Country | US
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Telephone | 79-891-5672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1599
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City | BANGOR
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State | ME
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Zip | 04402-1599
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Country | US
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Telephone |
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD13330
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 013330
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License Number State | ME
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