Provider Demographics
NPI:1629017553
Name:TRENKLE, DOUGLAS LEE (DO)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:LEE
Last Name:TRENKLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:50 UNION ST
Mailing Address - Street 2:ELLSWORTH INTERNAL MEDICINE
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1586
Mailing Address - Country:US
Mailing Address - Phone:207-664-5480
Mailing Address - Fax:207-664-5490
Practice Address - Street 1:306 MAIN ST
Practice Address - Street 2:MAINE COAST SPECIALTY CLINIC
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1510
Practice Address - Country:US
Practice Address - Phone:207-664-5566
Practice Address - Fax:207-664-5822
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME238620099Medicaid
MEB58138Medicare UPIN
ME238620099Medicaid