Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 12238 | NH |
N | 207N00000X | Dermatologist | 37789 | IA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 018570 | ME |
N | 207ND0101X | MOHS-Micrographic Surgeon | 12238 | NH |
N | 207ND0101X | MOHS-Micrographic Surgeon | 37789 | IA |
N | 207NS0135X | Procedural Dermatology | 37789 | IA |
N | 207R00000X | Internist | 12238 | NH |
N | 111NI0900X | Internist | 12238 | NH |
NPI | 1033224431 |
---|---|
Provider Name | Robert Macneal |
First Address | Portland, ME 04102-2645 |
Second Address | Portland, ME 04102-2645 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 17/02/2011 |