Healthcare Provider Details

I. General information

NPI: 1902168107
Provider Name (Legal Business Name): ANDREW PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FORE RIVER PKWY STE 410
PORTLAND ME
04102-2788
US

IV. Provider business mailing address

195 FORE RIVER PKWY STE 410
PORTLAND ME
04102-2788
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-9839
  • Fax: 833-438-1785
Mailing address:
  • Phone: 207-774-9839
  • Fax: 833-438-1785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD26211
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD26211
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: