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General NPI Number Information
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NPI Number | 1598945321
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Entity Type | Organization
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Legal Business Name | MACKLIN & ERVIN MDPA
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 11/08/2007
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Provider Practice Location Address
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Address Line | 2 SCHOOL ST
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City | WATERVILLE
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State | ME
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Zip | 04901-7518
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Country | US
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Telephone | 207-873-6183
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Fax | 207-861-5457
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Provider Business Mailing Address
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Address Line | 2 SCHOOL ST
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City | WATERVILLE
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State | ME
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Zip | 04901-7518
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Country | US
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Telephone | 207-873-6183
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Fax | 207-861-5457
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Authorized Official
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Title or Position | OWNER
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Name | DR. EDMUND DOLE ERVIN
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Credential | MD
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Telephone | 207-873-6183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 010650
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License Number State | ME
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