Healthcare Provider Details

I. General information

NPI: 1356540454
Provider Name (Legal Business Name): IOAN COSMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600B CONGRESS ST
PORTLAND ME
04102-2124
US

IV. Provider business mailing address

1600B CONGRESS ST
PORTLAND ME
04102-2124
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-5222
  • Fax: 207-761-4433
Mailing address:
  • Phone: 207-774-5222
  • Fax: 207-761-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD18449
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: