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General NPI Number Information
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NPI Number | 1841690377
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Entity Type | Organization
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Legal Business Name | PENOBSCOT FAMILY FOOT AND ANKLE CENTER
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 205 FRENCH ST
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City | BANGOR
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State | ME
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Zip | 04401-5064
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Country | US
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Telephone | 207-945-5554
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Fax | 207-945-5196
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Provider Business Mailing Address
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Address Line | 205 FRENCH ST
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City | BANGOR
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State | ME
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Zip | 04401-5064
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Country | US
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Telephone | 207-945-5554
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Fax | 207-945-5196
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. DIANE MARIA DESANTIS
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Credential |
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Telephone | 781-231-7026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | POD1032
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License Number State | ME
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