Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 013568 | ME |
NPI | 1013988112 |
---|---|
Provider Name | Ronald Cilley |
First Address | Bridgton, ME 04009-1156 |
Second Address | Bridgton, ME 04009-1156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 09/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C99278 | (02) | ME |