Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MD21127 | ME |
Y | 208600000X | Surgeon | MD21127 | ME |
N | 2086X0206X | Surgical Oncologist | 036140306 | IL |
NPI | 1275829699 |
---|---|
Provider Name | Elizabeth S.m. Desjardin |
First Address | Portland, ME 04103-1073 |
Second Address | Scarborough, ME 04074-7172 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 18/09/2017 |