Provider Demographics
NPI:1497186191
Name:LOMMLER, PA
Entity Type:Organization
Organization Name:LOMMLER, PA
Other - Org Name:ELMER H. LOMMLER MD
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOMMLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-922-4006
Mailing Address - Street 1:205 FRENCH STREET, SUITE 2
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5064
Mailing Address - Country:US
Mailing Address - Phone:207-922-4006
Mailing Address - Fax:207-922-4051
Practice Address - Street 1:205 FRENCH STREET, SUITE 2
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5064
Practice Address - Country:US
Practice Address - Phone:207-922-4006
Practice Address - Fax:207-922-4051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-05
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD9862305S00000X
ME9862305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty