Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 11236 | NH |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD22343 | ME |
NPI | 1043289739 |
---|---|
Provider Name | Taraneh Azar |
First Address | Kittery, ME 03904-1727 |
Second Address | Kittery, ME 03904 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 20/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3075199 | (05) | NH |
H41497 | (02) |