Provider Demographics
NPI:1871688812
Name:MOSENFELDER, ROBERT I (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:I
Last Name:MOSENFELDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HARTFORD ST
Mailing Address - Street 2:STE 4
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1844
Mailing Address - Country:US
Mailing Address - Phone:207-532-4017
Mailing Address - Fax:207-532-4019
Practice Address - Street 1:22 HARTFORD ST
Practice Address - Street 2:STE 4
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1844
Practice Address - Country:US
Practice Address - Phone:207-532-4017
Practice Address - Fax:207-532-4019
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12156207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117260000Medicaid
MEA72092Medicare UPIN
MM0603Medicare ID - Type Unspecified