MEDICARE: ATLANTIC MEDICINE LLC

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
1	175F00000X	Naturopath	NP366	ME

General Provider Information

NPI Number	:	1447505870
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC MEDICINE LLC

Provider Business Mailing Address
First Line	:	83 SAINT LAWRENCE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4333
Country	:	US
Telephone Number	:	207-233-3944
Fax Number	:

Provider Business Practice Location Address
First Line	:	83 SAINT LAWRENCE ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-4333
Country	:	US
Telephone Number	:	207-233-3944
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MASINA WRIGHT
Credential	:	ND
Telephone Number	:	207-233-3944

Provider Enumeration Date	:	07/23/2012
Last Update Date	:	07/23/2012

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