Provider Demographics
NPI:1548567068
Name:PANUNCIALMAN, JAYMIE FE POTENCIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYMIE FE
Middle Name:POTENCIANO
Last Name:PANUNCIALMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JAYMIE FE
Other - Middle Name:SERNAL
Other - Last Name:POTENCIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:381 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3446
Mailing Address - Country:US
Mailing Address - Phone:207-942-0669
Mailing Address - Fax:207-947-3143
Practice Address - Street 1:35 STATE HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-8816
Practice Address - Country:US
Practice Address - Phone:207-561-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20891207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology