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General NPI Number Information
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NPI Number | 1679251946
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Entity Type | Organization
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Legal Business Name | CASCO BAY DIRECT PRIMARY CARE
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 100 BRICKHILL AVE
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1999
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Country | US
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Telephone | 207-407-5027
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Fax |
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Provider Business Mailing Address
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Address Line | 80 OLD FIELD RD
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City | YARMOUTH
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State | ME
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Zip | 04096-7570
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Country | US
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Telephone | 207-776-0816
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JENNIFER BEALL
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Credential | MD
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Telephone | 207-407-5027
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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 |
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License Number State |
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