MEDICARE: STEPHAN O. BAMBERGER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD14080	ME
2	207P00000X	Emergency Medicine Physician	35.150092	OH

General Provider Information

NPI Number	:	1003881319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHAN O. BAMBERGER MD

Provider Business Mailing Address
First Line	:	331 MAINE ST
Second Line	:	SUITE 5
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-3358
Country	:	US
Telephone Number	:	207-798-6974
Fax Number	:	207-798-6981

Provider Business Practice Location Address
First Line	:	15 GRACELAWN RD
Second Line	:
City	:	AUBURN
State	:	ME
Zip	:	04210-6334
Country	:	US
Telephone Number	:	207-333-4799
Fax Number	:	207-333-4767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	04/05/2024

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