Provider Demographics
NPI:1972529865
Name:BATES MILL DERMATOLOGY, P.L.L.C.
Entity type:Organization
Organization Name:BATES MILL DERMATOLOGY, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-795-7540
Mailing Address - Street 1:70 LINCOLN ST
Mailing Address - Street 2:MILL 6
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7721
Mailing Address - Country:US
Mailing Address - Phone:207-795-7540
Mailing Address - Fax:207-795-7528
Practice Address - Street 1:70 LINCOLN ST
Practice Address - Street 2:MILL 6
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7721
Practice Address - Country:US
Practice Address - Phone:207-795-7540
Practice Address - Fax:207-795-7528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016653207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1775Medicare ID - Type Unspecified