Healthcare Provider Details

I. General information

NPI: 1932410883
Provider Name (Legal Business Name): CHRISTOPHER TODD KITCHENS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MAIN ST
PORTER ME
04068-3527
US

IV. Provider business mailing address

70 MAIN ST
PORTER ME
04068-3527
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-8126
  • Fax: 207-625-7820
Mailing address:
  • Phone: 207-625-8126
  • Fax: 207-625-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2277
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: