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PENOBSCOT VALLEY DERMATOLOGY, P.A.
NPI 1952536880
Specialist in Bangor, ME

Active since May 21, 2009
90 RIDGEWOOD DRIVE, BANGOR, ME 04401(207) 942-0669(207) 947-3143 Get Directions Write a Review

NPPES record last updated: June 3, 2009. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Penobscot Valley Dermatology, P.a. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PENOBSCOT VALLEY DERMATOLOGY, P.A. (NPI 1952536880) is a healthcare organization registered as a specialist in Bangor, Maine and active in the NPI registry since May 2009. The organization lists Jeffrey Dean Pittis, Dermatologist, as its authorized official.

NPPES Registry Identity

NPI1952536880
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NamePENOBSCOT VALLEY DERMATOLOGY, P.A.
Location Address90 RIDGEWOOD DRIVEBangor, ME 04401-2652
Mailing Address90 Ridgewood DriveBangor, ME 04401-2652 · (207) 942-0669 · Fax (207) 947-3143
Phone(207) 942-0669
Fax(207) 947-3143
Organization SubpartNo
Authorized OfficialJeffrey Dean PittisDermatologist · (207) 942-0669
Enumeration DateMay 21, 2009
Last NPPES UpdateJune 3, 2009
✔ NPI 1952536880 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in ME · ME013153
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
90 RIDGEWOOD DRIVE, Bangor, ME 04401
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Other Identifiers 1

Medicare UPINE98841ME

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Penobscot Valley Dermatology, P.a. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Penobscot Valley Dermatology, P.A., which bills Medicare for the services they deliver. Of these, 3 practice at this address and 8 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Holly Haeberlein
Nurse Practitioner
NPI 1932537800
90 RIDGEWOOD DR
Bangor, ME 04401
(207) 942-0669
✔ PECOS✔ Accepts MedicareSame address
Samantha Mitchell, FNP-C
Nurse Practitioner
NPI 1861755209
90 RIDGEWOOD DR
Bangor, ME 04401
(207) 942-0669
✔ PECOS✔ Accepts MedicareSame address
Amy Sim, NP
Nurse Practitioner
NPI 1669670139
90 RIDGEWOOD DR
Bangor, ME 04401
(207) 942-0669
✔ PECOS✔ Accepts MedicareSame address
Faith Whalen, MD
Dermatology
NPI 1124256029
90 RIDGEWOOD DR
Bangor, ME 04401
(207) 942-0669
✔ PECOS✔ Accepts Medicare0.1 mi
Jaymie Fe Panuncialman, M.D.
Dermatology
NPI 1548567068
35 STATE HOSPITAL DR
Bangor, ME 04401
(207) 561-3600
✔ PECOS2.3 mi
Carolyn Ellis, DO
Dermatology
NPI 1841555398
498 ESSEX ST STE 106
Bangor, ME 04401
(207) 942-0669
✔ PECOS✔ Accepts Medicare2.4 mi
Orville Hartford, M.D.
Dermatology
NPI 1053437780
381 MAIN ST
Orono, ME 04473
(207) 942-0669
✔ PECOS✔ Accepts Medicare2.8 mi
Catherina Tribou
Nurse Practitioner
NPI 1538882634
381 MAIN ST
Orono, ME 04473
(207) 942-0669
✔ PECOS✔ Accepts Medicare2.8 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Penobscot Valley Dermatology, P.A.'s NPI number?

The NPI number for Penobscot Valley Dermatology, P.A. is 1952536880. It was assigned to this organization in the NPPES registry on May 21, 2009.

Where is Penobscot Valley Dermatology, P.A. located?

Penobscot Valley Dermatology, P.A. is located at 90 Ridgewood Drive, Bangor, ME 04401. The listed phone number is (207) 942-0669.

What is Penobscot Valley Dermatology, P.A.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Penobscot Valley Dermatology, P.A. enrolled in Medicare?

Yes. Penobscot Valley Dermatology, P.A. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Penobscot Valley Dermatology, P.A.?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 2 Medicare specialties reassign their Medicare billing to Penobscot Valley Dermatology, P.A.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (4) and Nurse Practitioner (4). Of these, 3 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Penobscot Valley Dermatology, P.A. was last updated on June 3, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.