Facts
- Status
- A
- Credential
- LMT
- Type
- Individual
- Enumeration date
- 2008-12-18
- Last updated
- 2008-12-18
Specialties
Licenses
- License ME
- MT2101
Location
- Practice location
- 72 FRONT ST, SUITE 16
- City
- BATH ME
- Postal code
- 045302657
- Phone
- 207-522-4092
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.