Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | DO2888 | ME |
NPI | 1013301274 |
---|---|
Provider Name | Tasha Duval |
First Address | Farmington, CT 06030-2947 |
Second Address | Lewiston, ME 04240-7027 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2015 |
Last Update Date | 07/06/2019 |