Healthcare Provider Details

I. General information

NPI: 1982847000
Provider Name (Legal Business Name): DOUGLAS DELLEFEMINE LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SAINT JOHN ST SUITE 214
PORTLAND ME
04102-3041
US

IV. Provider business mailing address

222 SAINT JOHN ST SUITE 214
PORTLAND ME
04102-3041
US

V. Phone/Fax

Practice location:
  • Phone: 207-871-7657
  • Fax: 207-347-7898
Mailing address:
  • Phone: 207-871-7657
  • Fax: 207-347-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT4003
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: