Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 013155 | ME |
Y | 2080P0205X | Pediatric Endocrinologist | 013155 | ME |
NPI | 1386673382 |
---|---|
Provider Name | Jerrold Olshan |
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 | 02/07/2006 |
Last Update Date | 26/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30008631 | (05) | NH |
322340099 | (05) | ME |
E97064 | (02) | ME |