Provider Demographics
NPI:1346618741
Name:BREDENBERG, CARL E JR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:BREDENBERG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 FOX HILL RD
Mailing Address - Street 2:
Mailing Address - City:CAPE ELIZABETH
Mailing Address - State:ME
Mailing Address - Zip Code:04107-2007
Mailing Address - Country:US
Mailing Address - Phone:207-799-3345
Mailing Address - Fax:
Practice Address - Street 1:8 FOX HILL RD
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-2007
Practice Address - Country:US
Practice Address - Phone:207-799-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD129012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery