Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Parent organization
PENOBSCOT COMMUNITY HEALTH CENTER
Other names
Penobscot Pediatrics
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Authorized official
LORI L. DWYER ESQ. (PRESIDENT & CEO)
(207) 992-9200
Entity
Organization
Contact information
Practice address
6 TELCOM DR, BANGOR, ME 04401-3072
(207) 947-0147
(207) 990-3365
Mailing address
PO BOX 1599, 103 MAINE AVE, BANGOR, ME 04402-1599
(207) 945-5247
(207) 992-2154
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
201872
ME
Other
Enumeration date
10/02/2006
Last updated
11/07/2019
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