Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD18653 | ME |
N | 207QG0300X | Family Doctor - Geriatric Medicine | MD18653 | ME |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD18653 | ME |
NPI | 1386761567 |
---|---|
Provider Name | Cosmina I Fachiol |
First Address | Brewer, ME 04412-1005 |
Second Address | Bangor, ME 04401-6616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 17/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1386761567 | (05) | ME |
434739399 | (05) | ME |