Provider Demographics
NPI:1104847110
Name:DAHL CHASE DIAGNOSTIC SERVICES
Entity Type:Organization
Organization Name:DAHL CHASE DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-941-8223
Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6635
Mailing Address - Country:US
Mailing Address - Phone:207-941-8270
Mailing Address - Fax:207-990-4848
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 440
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-561-2400
Practice Address - Fax:207-990-4848
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAHL-CHASE PATHOLOGY ASSOC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20D0936816291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME113950000Medicaid
ME113950000Medicaid
MEMM6074Medicare PIN
MEP00387915Medicare PIN