Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 19720 | ME |
N | 111NI0900X | Internist | 19720 | ME |
Y | 207RC0200X | Critical Care Medicine | 19720 | ME |
N | 207RP1001X | Pulmonary Disease | 19720 | ME |
N | 207RS0012X | Sleep Medicine | 19720 | ME |
NPI | 1043274509 |
---|---|
Provider Name | Dr. Trustin Roy Ennacheril |
First Address | Kittery, ME 03904-5527 |
Second Address | Kittery, ME 03904-5527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 02/11/2020 |