Provider Demographics
NPI:1952418949
Name:FOLLWEILER, BRENT S (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:S
Last Name:FOLLWEILER
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 1:62 PREBLE LANE
Mailing Address - Street 2:
Mailing Address - City:BROOKLIN
Mailing Address - State:ME
Mailing Address - Zip Code:04616
Mailing Address - Country:US
Mailing Address - Phone:207-359-2075
Mailing Address - Fax:207-359-2075
Practice Address - Street 1:62 PREBLE LANE
Practice Address - Street 2:
Practice Address - City:BROOKLIN
Practice Address - State:ME
Practice Address - Zip Code:04616
Practice Address - Country:US
Practice Address - Phone:207-359-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029214L207L00000X
ME015571207L00000X
VT0420011062207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
438525Medicare ID - Type Unspecified
B41834Medicare UPIN