Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 595 | ME |
NPI | 1063543221 |
---|---|
Provider Name | Dr. Leonard George Saulter |
First Address | Falmouth, ME 04105-1796 |
Second Address | Falmouth, ME 04105-1796 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 06/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002320 | ANTHEM (01) | ME |
010390802 | TAX ID (01) | ME |
113840000 | (05) | ME |