Facts
- Status
- A
- Credential
- PA
- Type
- Individual
- Enumeration date
- 2006-03-09
- Last updated
- 2007-08-30
Specialties
Licenses
- License ME
- PA676
Location
- Practice location
- 180 CHURCH HILL RD, STE 1
- City
- LEEDS ME
- Postal code
- 042633418
- Phone
- 207-524-3501
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.