Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 224852 | MA |
Y | 2080P0205X | Pediatric Endocrinologist | 017981 | ME |
NPI | 1093781254 |
---|---|
Provider Name | Dr. Michael A Dedekian |
First Address | Scarborough, ME 04074-7609 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2110318 | (05) | MA |
30208479 | (05) | NH |
433775099 | (05) | ME |
I32448 | (02) | MA |