Healthcare Provider Details

I. General information

NPI: 1760151138
Provider Name (Legal Business Name): MARIANNA KONRADI OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 WALTON DR STE A6
BREWER ME
04412-1001
US

IV. Provider business mailing address

24 WALTON DR STE A6
BREWER ME
04412-1001
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-1492
  • Fax: 844-801-2454
Mailing address:
  • Phone: 207-200-1492
  • Fax: 844-801-2454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIANNA KONRADI
Title or Position: SINGLE MEMBER OWNER
Credential: OD
Phone: 207-200-1492