Organization
WELL WOMAN CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN M CORBETT (BILLING REPRESENTATIVE)
(207) 497-2996
Entity
Organization
Contact information
Practice address
174 S FREEPORT RD, SUITE 1A, FREEPORT, ME 04032-6145
(207) 865-7088
Mailing address
174 S FREEPORT RD, STE. 1A, FREEPORT, ME 04032-6145
(207) 497-2996
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
012979
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1912133943
BCBS
ME
05
—
434287100
—
ME
Enumeration date
06/04/2009
Last updated
11/08/2011
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