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Physicians Psychiatry & Neurology Psychiatry

Provider NPI: 1740344902

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 908-240-3106  Fax: 207-747-5129

Business Mailing Address:
PO BOX 2278  SOUTH PORTLAND, ME 04116-2278 US
Tel: 908-240-3106  Fax: 207-747-5129

NPI Information:
NPI: 1740344902
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Psychiatry & Neurology

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 2084P0800X





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