Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 015532 | ME |
Y | 208600000X | Surgeon | 015532 | ME |
NPI | 1023102449 |
---|---|
Provider Name | Virginia A Eddy |
First Address | Scarborough, ME 04074-7609 |
Second Address | Portland, ME 04102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 04/01/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30201751 | (05) | NH |
338680099 | (05) | ME |
F33756 | (02) |