Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 42169 | MN |
N | 208600000X | Surgeon | 42169 | MN |
N | 208200000X | Surgeon | 56517 | WI |
N | 208600000X | Surgeon | 56517 | WI |
Y | 208200000X | Surgeon | MD23361 | ME |
Y | 208600000X | Surgeon | MD23361 | ME |
N | 2086S0102X | Surgical Critical Care | 56517 | WI |
N | 2086S0102X | Surgical Critical Care | MD23361 | ME |
N | 2086S0127X | Trauma Surgeon | MD23361 | ME |
NPI | 1124005806 |
---|---|
Provider Name | Dr. Daniel C. Cullinane |
First Address | Portland, ME 04102-3166 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 06/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
143428400 | (05) | MN |
APPR | (05) | WI |