Provider Demographics
NPI:1215010889
Name:JENSEN, CHARMAINE B (DO)
Entity Type:Individual
Prefix:
First Name:CHARMAINE
Middle Name:B
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 ATLANTIC HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-5310
Mailing Address - Country:US
Mailing Address - Phone:207-230-1007
Mailing Address - Fax:207-230-1008
Practice Address - Street 1:2239 ATLANTIC HWY
Practice Address - Street 2:
Practice Address - City:LINCOLNVILLE
Practice Address - State:ME
Practice Address - Zip Code:04849-5310
Practice Address - Country:US
Practice Address - Phone:207-230-1007
Practice Address - Fax:207-230-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME18222086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME0826Medicare ID - Type Unspecified