Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 011760 | ME |
N | 2080P0201X | Pediatric Allergist | 011760 | ME |
NPI | 1497793210 |
---|---|
Provider Name | Barbara Chilmonczyk |
First Address | Portland, ME 04102 |
Second Address | Portland, ME 04102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 14/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E35276 | (02) | ME |