Healthcare Provider Details

I. General information

NPI: 1194772970
Provider Name (Legal Business Name): KENNETH G CHRISTIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 KINGSLAND XING STE A
ELLSWORTH ME
04605-2570
US

IV. Provider business mailing address

557 SOUTH RD
HOLDEN ME
04429-7531
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5340
  • Fax: 207-664-5338
Mailing address:
  • Phone: 207-949-5700
  • Fax: 207-664-5338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number012244
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number012244
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: