Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | DO2467 | ME |
Y | 111NI0900X | Internist | DO2467 | ME |
N | 207RH0002X | Hospice and Palliative Medicine | DO2467 | ME |
NPI | 1366738890 |
---|---|
Provider Name | Rebecca E Kowaloff |
First Address | Portland, ME 04103-1073 |
Second Address | Portland, ME 04102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2011 |
Last Update Date | 04/09/2018 |