Healthcare Provider Details

I. General information

NPI: 1447505870
Provider Name (Legal Business Name): ATLANTIC MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 07/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 SAINT LAWRENCE ST
PORTLAND ME
04101-4333
US

IV. Provider business mailing address

83 SAINT LAWRENCE ST
PORTLAND ME
04101-4333
US

V. Phone/Fax

Practice location:
  • Phone: 207-233-3944
  • Fax:
Mailing address:
  • Phone: 207-233-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNP366
License Number StateME

VIII. Authorized Official

Name: DR. MASINA WRIGHT
Title or Position: OWNER
Credential: ND
Phone: 207-233-3944