Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 014378 | ME |
NPI | 1003862046 |
---|---|
Provider Name | Dag Holmsen |
First Address | Augusta, ME 04330-8160 |
Second Address | Waterville, ME 04901-4974 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 18/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
032517 | ANTHEM (01) | ME |
1041924 | AETNA (01) | ME |
284140099 | (05) | ME |
3119772 | CIGNA (01) | ME |
G34673 | (02) | ME |
G34673 | HARVARD (01) | ME |