Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 5423 | AK |
Y | 2086S0120X | Pediatric Surgery | MD18028 | ME |
NPI | 1447330410 |
---|---|
Provider Name | Ian R Neilson |
First Address | Scarborough, ME 04074-7609 |
Second Address | Portland, ME 04102-3100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 26/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30208266 | (05) | NH |
433399099 | (05) | ME |
MD98332 | (05) | AK |