Healthcare Provider Details

I. General information

NPI: 1356044168
Provider Name (Legal Business Name): FRANCES ELLEN KIMBALL RUSSO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FRANCES ELLEN KIMBALL DO

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7041
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7041
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax:
Mailing address:
  • Phone: 207-795-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO4299
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: