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NPI Code Detail

MEDICARE: JOHN A KUSTAN M.D.

MEDICARE: JOHN A KUSTAN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianME18919ME

General Provider Information

NPI Number : 1386625077
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A KUSTAN M.D.
Provider Business Mailing Address
First Line : 324 GANNETT DR STE 200
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-3266
Country : US
Telephone Number : 207-482-7800
Fax Number :
Provider Business Practice Location Address
First Line : 3073 WHITE MOUNTAIN HWY
Second Line :
City : NORTH CONWAY
State : NH
Zip : 03860-7101
Country : US
Telephone Number : 603-356-5461
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 11/04/2015

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