Provider Demographics
NPI:1821233230
Name:KENDALL, DOREEN M (D O)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:M
Last Name:KENDALL
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:MIDCOAST MEDICINE, PA
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-1079
Mailing Address - Country:US
Mailing Address - Phone:207-236-2169
Mailing Address - Fax:207-230-0413
Practice Address - Street 1:1112 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-3802
Practice Address - Country:US
Practice Address - Phone:207-236-2169
Practice Address - Fax:207-230-0413
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2212204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6528Medicare PIN