Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35073229 | OH |
N | 207Q00000X | Family Doctor | D80007 | MD |
N | 207Q00000X | Family Doctor | MD22180 | ME |
Y | 207SG0201X | Clinical Genetics (M.D.) | MD22180 | ME |
NPI | 1386602290 |
---|---|
Provider Name | Dr. Nathan James Leu |
First Address | Portland, ME 04102-2169 |
Second Address | Portland, ME 04102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 17/06/2021 |