PENOBSCOT VALLEY DERMATOLOGY P.A. NPI 1952536880

NPI Information

PENOBSCOT VALLEY DERMATOLOGY, P.A. is a specialist in Bangor, ME. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. PENOBSCOT VALLEY DERMATOLOGY, P.A. NPI is 1952536880. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

90 RIDGEWOOD DRIVE
BANGOR, ME
ZIP 04401-652
Phone: (207) 942-0669
Fax: (207) 947-3143

The provider's authorized official is Jeffrey Dean Pittis .
The authorized official title is Dermatologist and has the following contact phone number (207) 942-0669.

The CLIA number assigned to this NPI record is 20D2187500 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 5/21/2009 and was last updated on 6/3/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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