Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | DO2877 | ME |
NPI | 1255727814 |
---|---|
Provider Name | Christopher James Lonegan |
First Address | South Portland, ME 04106-3266 |
Second Address | Windham, ME 04062-5554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 09/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1255727814 | (05) | ME |