Provider Demographics
NPI:1023377140
Name:MID COAST DERMATOLOGY, LLC
Entity Type:Organization
Organization Name:MID COAST DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HELGE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-406-2735
Mailing Address - Street 1:85 BARIBEAU DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3249
Mailing Address - Country:US
Mailing Address - Phone:207-406-2735
Mailing Address - Fax:207-406-2763
Practice Address - Street 1:85 BARIBEAU DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3249
Practice Address - Country:US
Practice Address - Phone:207-406-2735
Practice Address - Fax:207-406-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-09
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017897207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty