Provider Demographics
NPI:1275813933
Name:CINDY ASBJORNSEN DO LLC
Entity Type:Organization
Organization Name:CINDY ASBJORNSEN DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:B
Authorized Official - Last Name:ASBJORNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-221-3919
Mailing Address - Street 1:100 FODEN RD
Mailing Address - Street 2:SUITE 307 W
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2327
Mailing Address - Country:US
Mailing Address - Phone:207-221-3919
Mailing Address - Fax:719-314-2908
Practice Address - Street 1:100 FODEN RD
Practice Address - Street 2:SUITE 307 W
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2327
Practice Address - Country:US
Practice Address - Phone:207-221-3919
Practice Address - Fax:719-314-2908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2016207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME2016OtherSTATE LICENSE NUMBER
ME0003572Medicare PIN