Healthcare Provider Details

I. General information

NPI: 1700253671
Provider Name (Legal Business Name): YUSUF ABDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PLEASANT ST
OAKLAND ME
04963-5074
US

IV. Provider business mailing address

9 PLEASANT ST
OAKLAND ME
04963-5074
US

V. Phone/Fax

Practice location:
  • Phone: 207-465-2181
  • Fax: 207-465-4629
Mailing address:
  • Phone: 207-465-2181
  • Fax: 207-465-4629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1557
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: