Provider Demographics
NPI:1841308806
Name:FERNOW MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:FERNOW MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:MONTGOMERY
Authorized Official - Last Name:FERNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-564-7131
Mailing Address - Street 1:1048 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-1232
Mailing Address - Country:US
Mailing Address - Phone:207-564-7131
Mailing Address - Fax:207-564-7209
Practice Address - Street 1:1048 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1232
Practice Address - Country:US
Practice Address - Phone:207-564-7131
Practice Address - Fax:207-564-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEC66241Medicare UPIN
ME022208Medicare ID - Type UnspecifiedMEDICARE #