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General NPI Number Information
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NPI Number | 1790807139
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Entity Type | Organization
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Legal Business Name | SHIPMAN PEDIATRICS, LLC
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Dates
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Enumeration Date | 04/05/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 1 BRICKYARD LN UNIT D
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City | YORK
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State | ME
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Zip | 03909-1604
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Country | US
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Telephone | 207-497-2996
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Fax | 207-497-3467
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Provider Business Mailing Address
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Address Line | 541 MASON BAY RD
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City | JONESPORT
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State | ME
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Zip | 04649-3501
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Country | US
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Telephone | 207-497-2996
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Fax | 207-497-3467
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Authorized Official
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Title or Position | OWNER
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Name | RUSSELL SHIPMAN
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Credential | M.D.
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Telephone | 207-497-2996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1575
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License Number State | ME
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