Provider Demographics
NPI:1497799720
Name:PENOBSCOT BAY PHYSICIANS & ASSOCIATES
Entity Type:Organization
Organization Name:PENOBSCOT BAY PHYSICIANS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-596-8903
Mailing Address - Street 1:3 GLEN COVE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4232
Mailing Address - Country:US
Mailing Address - Phone:207-596-8910
Mailing Address - Fax:207-593-5302
Practice Address - Street 1:3 GLEN COVE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4232
Practice Address - Country:US
Practice Address - Phone:207-596-8910
Practice Address - Fax:207-593-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM8079Medicare ID - Type Unspecified