Healthcare Provider Details

I. General information

NPI: 1427123306
Provider Name (Legal Business Name): CYNTHIA A PATRAITIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2006
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEALTHCARE DR SUITE 208
BIDDEFORD ME
04005-9449
US

IV. Provider business mailing address

1 MEDICAL CENTER DR PO BOX 626
BIDDEFORD ME
04005-9422
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-7531
  • Fax: 207-286-3787
Mailing address:
  • Phone: 207-282-7531
  • Fax: 207-286-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2059
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: