Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 828 | ME |
NPI | 1285869420 |
---|---|
Provider Name | Dr. Chester C Suske |
First Address | Portland, ME 04103-1889 |
Second Address | Portland, ME 04103-1889 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2009 |
Last Update Date | 01/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E41069 | (02) | ME |