Provider Demographics
NPI:1053886184
Name:PENOBSCOT VALLEY FOOT AND ANKLE
Entity type:Organization
Organization Name:PENOBSCOT VALLEY FOOT AND ANKLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-794-7214
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0021
Mailing Address - Country:US
Mailing Address - Phone:207-794-7214
Mailing Address - Fax:207-794-3315
Practice Address - Street 1:7 TRANSALPINE RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4222
Practice Address - Country:US
Practice Address - Phone:215-910-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty