Provider Demographics
NPI:1619021987
Name:DIRK VANDERSLOOT, MD
Entity Type:Organization
Organization Name:DIRK VANDERSLOOT, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERSLOOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-596-0991
Mailing Address - Street 1:17 MASONIC ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-2808
Mailing Address - Country:US
Mailing Address - Phone:207-596-0991
Mailing Address - Fax:207-596-0213
Practice Address - Street 1:17 MASONIC ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2808
Practice Address - Country:US
Practice Address - Phone:207-596-0991
Practice Address - Fax:207-596-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty