Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 012127 | ME |
NPI | 1134100332 |
---|---|
Provider Name | Alexander L Mesrobian |
First Address | Damariscotta, ME 04543-4047 |
Second Address | Damariscotta, ME 04543-4047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2005 |
Last Update Date | 18/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A68220 | (02) |