Healthcare Provider Details

I. General information

NPI: 1407233497
Provider Name (Legal Business Name): LAUREN NADKARNI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 HIGH ST
LEWISTON ME
04240-7649
US

IV. Provider business mailing address

PO BOX 4100
LEWISTON ME
04243-4100
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD22950
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD22950
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: