MEDICARE: GLENN D. FOCHT M.D.

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	207R00000X	Internal Medicine Physician	018536	ME

General Provider Information

NPI Number	:	1831138148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN D. FOCHT M.D.

Provider Business Mailing Address
First Line	:	12 HIGH ST
Second Line	:	STE. 402
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5700
Fax Number	:	207-795-5727

Provider Business Practice Location Address
First Line	:	12 HIGH ST
Second Line	:	STE. 402
City	:	LEWISTON
State	:	ME
Zip	:	04240-7676
Country	:	US
Telephone Number	:	207-795-5700
Fax Number	:	207-795-5727

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/15/2010

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