Healthcare Provider Details

I. General information

NPI: 1306013180
Provider Name (Legal Business Name): MARTHA BEAR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA MAY CORDIOLI

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

IV. Provider business mailing address

2 LIVEWELL DR
KENNEBUNK ME
04043-6762
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number031.0133499
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: