Individual
BETHANY T LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10 GOODALL DRIVE, SUITE 100, E. WATERBORO, ME 04030
(207) 490-7970
(207) 282-9128
Mailing address
1 MEDICAL CENTER DRIVE, PO BOX 626, BIDDEFORD, ME 04005
(207) 282-9080
(207) 282-9180
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015660
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247150099
—
ME
Enumeration date
04/12/2006
Last updated
12/18/2014
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