Healthcare Provider Details

I. General information

NPI: 1497793210
Provider Name (Legal Business Name): BARBARA CHILMONCZYK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FORE RIVER PKWY SUITE 410
PORTLAND ME
04102
US

IV. Provider business mailing address

195 FORE RIVER PKWY SUITE 410
PORTLAND ME
04102
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-9839
  • Fax: 207-761-2127
Mailing address:
  • Phone: 207-774-9839
  • Fax: 207-761-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number011760
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number011760
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number011760
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: