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NPI Code Detail

MEDICARE: PENBAY ANESTHESIA, LLC

MEDICARE: PENBAY ANESTHESIA, LLC
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
1207L00000XAnesthesiology Physician

General Provider Information

NPI Number : 1629054663
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENBAY ANESTHESIA, LLC
Provider Business Mailing Address
First Line : PO BOX 1849
Second Line :
City : LEWISTON
State : ME
Zip : 04241-1849
Country : US
Telephone Number : 207-784-2554
Fax Number : 207-777-5363
Provider Business Practice Location Address
First Line : 6 GLEN COVE DR
Second Line :
City : ROCKPORT
State : ME
Zip : 04856-4240
Country : US
Telephone Number : 207-596-8000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DAVID MADDOX
Credential : M.D.
Telephone Number : 207-784-2554
Provider Enumeration Date : 12/21/2005
Last Update Date : 07/16/2007

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Directions to “PENBAY ANESTHESIA, LLC ” Practice Location

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