Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD19259 | ME |
Y | 2080P0210X | Pediatric Nephrologist | MD19259 | ME |
NPI | 1043492473 |
---|---|
Provider Name | Marie H Tanzer |
First Address | Scarborough, ME 04074-9701 |
Second Address | Portland, ME 04102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2007 |
Last Update Date | 30/10/2012 |