Individual
DR. JUSTIN ADAM BUSSONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
123 MEDICAL CENTER DR, BRUNSWICK, ME 04011-2652
(207) 373-6000
Mailing address
123 MEDICAL CENTER DR, BRUNSWICK, ME 04011-2652
(207) 373-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
DO2129
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61193
BILLING NUMBER
NH
01
—
DO2129
MAINE LICENSE
ME
01
—
RT- 1553
LICENSE NUMBER
NH
Enumeration date
08/22/2006
Last updated
05/17/2016
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