Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 014348 | ME |
Y | 2086S0127X | Trauma Surgeon | 014348 | ME |
NPI | 1184718694 |
---|---|
Provider Name | Brad Cushing |
First Address | Scarborough, ME 04074-7609 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
290140099 | (05) | ME |
30010638 | (05) | NH |
D70351 | (02) |