Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | MD24528 | ME |
NPI | 1003310277 |
---|---|
Provider Name | Mr. Nicholas Emmanuel Walter |
First Address | Damariscotta, ME 04543 |
Second Address | Damariscotta, ME 04543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 23/07/2021 |