Provider Demographics
NPI:1639118458
Name:CHLEBOWSKI, JAMES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:CHLEBOWSKI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6030
Mailing Address - Country:US
Mailing Address - Phone:207-832-6394
Mailing Address - Fax:207-832-4392
Practice Address - Street 1:592 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6030
Practice Address - Country:US
Practice Address - Phone:207-832-6394
Practice Address - Fax:207-832-4392
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047550L207Q00000X
MEMD27083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016478280006Medicaid
PA028164F6KMedicare PIN
PA028164F6KMedicare PIN