Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 12311 | ME |
NPI | 1184618316 |
---|---|
Provider Name | Marguerite Anne Pennoyer |
First Address | Scarborough, ME 04074-9030 |
Second Address | Scarborough, ME 04074-9030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2005 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C66319 | (02) | |
E004030 | CHAMPUS (01) | ME |
M5650 | CIGNA (01) | ME |
P0154 | BCBS (01) | ME |