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Individual

JENS ELDRUP-JORGENSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
887 CONGRESS ST, SUITE 400, PORTLAND, ME 04102-3100
(207) 774-6368
(207) 774-9388
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD12526
ME
2086S0129X
Vascular Surgery Physician
MD12526
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020010747
RR MEDICARE
ME
05
297770099
ME
05
300002506
NH
Enumeration date
12/22/2005
Last updated
10/14/2013
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