Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 22315 | ME |
NPI | 1134417462 |
---|---|
Provider Name | Dr. David Pantino |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2011 |
Last Update Date | 20/11/2018 |