Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 017151 | ME |
N | 2080P0201X | Pediatric Allergist | 017151 | ME |
NPI | 1215038088 |
---|---|
Provider Name | Dr. Ivan D Cardona |
First Address | Portland, ME 04102 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 13/01/2015 |