Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | AC625 | ME |
N | 207QS0010X | Family Doctor - Sports Medicine | AC625 | ME |
NPI | 1063064285 |
---|---|
Provider Name | Victoria A Deane |
First Address | Portland, ME 04104-4239 |
Second Address | Portland, ME 04103-4224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2019 |
Last Update Date | 09/07/2019 |