Provider Demographics
NPI:1538518170
Name:ISENHOWER, LORI S (DO)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:ISENHOWER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 WHITING HILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1005
Mailing Address - Country:US
Mailing Address - Phone:207-973-5000
Mailing Address - Fax:207-973-5042
Practice Address - Street 1:895 UNION ST
Practice Address - Street 2:SUITE 12
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3053
Practice Address - Country:US
Practice Address - Phone:207-973-7979
Practice Address - Fax:207-945-9579
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
MEDO2917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program