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Physicians Orthopaedic Surgery Sports Medicine

Provider NPI: 1790785632

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
33 SEWALL ST  PORTLAND, ME 04102-2603 US
Tel: 207-828-2100  Fax: --

Business Mailing Address:
324 GANNETT DR STE 200  PORTLAND, ME 04106-3266 US
Tel: 207-482-7800  Fax: --

NPI Information:
NPI: 1790785632
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Orthopaedic Surgery
Sports Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207XX0005X





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