Healthcare Provider Details

I. General information

NPI: 1659497444
Provider Name (Legal Business Name): FAMILY EAR, NOSE & THROAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 WALKER ST STE 200
KITTERY ME
03904-1727
US

IV. Provider business mailing address

35 WALKER ST STE 200
KITTERY ME
03904-1727
US

V. Phone/Fax

Practice location:
  • Phone: 207-475-0100
  • Fax: 207-351-3524
Mailing address:
  • Phone: 207-351-3525
  • Fax: 207-351-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. LESLIE N RANKIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 207-475-0100