Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 018170 | ME |
NPI | 1053437780 |
---|---|
Provider Name | Dr. Orville Albert Hartford |
First Address | Bangor, ME 04401-2652 |
Second Address | Bangor, ME 04401-2652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 12/02/2010 |