Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 1633 | ME |
N | 207Q00000X | Family Doctor | 1633 | ME |
Y | 207Q00000X | Family Doctor | DO1633 | ME |
NPI | 1619943917 |
---|---|
Provider Name | Kathryn Brandt |
First Address | Biddeford, ME 04005 |
Second Address | Saco, ME 04072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2006 |
Last Update Date | 31/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1619943917 | (05) | ME |
276370099 | (05) | ME |
H17234 | (02) | ME |