Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1860 | ME |
N | 207Q00000X | Family Doctor | 1860 | ME |
NPI | 1043257561 |
---|---|
Provider Name | Dr. Adi Michelle Philpott |
First Address | Portland, ME 04103-2512 |
Second Address | Portland, ME 04103-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 07/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H42004 | (02) |