MEDICARE: MARK JENSEN D.O.

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	2084P0800X	Psychiatry Physician	1823	ME

General Provider Information

NPI Number	:	1003990706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JENSEN D.O.

Provider Business Mailing Address
First Line	:	2239 ATLANTIC HWY
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849-5310
Country	:	US
Telephone Number	:	207-236-0214
Fax Number	:	207-230-1008

Provider Business Practice Location Address
First Line	:	2239 ATLANTIC HWY
Second Line	:
City	:	LINCOLNVILLE
State	:	ME
Zip	:	04849-5310
Country	:	US
Telephone Number	:	207-236-0214
Fax Number	:	207-230-1008

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	01/28/2013

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