Organization
BLACK DOG MEDICAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA WYSHAK MD (OWNER)
(207) 200-1464
Entity
Organization
Contact information
Practice address
11 MADISON AVENUE, LAMOINE, ME 04605
(207) 200-1464
(207) 805-8421
Mailing address
11 MADISON AVENUE, LAMOINE, ME 04605
(207) 200-1464
(207) 805-8421
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD14569
ME
Other
Enumeration date
04/01/2016
Last updated
04/01/2016
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