Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 0101240575 | VA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD22718 | ME |
NPI | 1083781264 |
---|---|
Provider Name | Dr. Shannon M Marchegiani |
First Address | Brewer, ME 04412-1006 |
Second Address | Bangor, ME 04401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 24/01/2019 |