Black Dog Medical PA

NPI #1154784668 in Lamoine, Maine

Provider Information

NPI Number: 1154784668
Entity Type: Organization
Organization Name: Black Dog Medical PA
Primary Specialty: Internal Medicine
Enumeration Date: Apr 1, 2016
Last Updated: Apr 1, 2016

Practice Location

Address: 11 MADISON AVENUE
City: Lamoine
State: Maine
ZIP Code: 04605
Phone: (207) 200-1464

Authorized Official

Name: PATRICIA WYSHAK, MD
Title: OWNER
Phone: (207) 200-1464

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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