NPI 1104919901 · live from the CMS NPI Registry
Robert Wynne Haeberlein, MD
Dermatology in Bangor, ME. National Provider Identifier 1104919901, active.
NPI record
| NPI | 1104919901 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Dermatology 207N00000X |
| Practice location | 700 Mount Hope Avenue Suite 601, Bangor, ME 04401 |
| Practice phone | 207-942-4653 |
| Enumerated | October 2, 2006 |
| Last updated | June 22, 2009 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dermatology primary | 207N00000X | 009794 (ME) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.