Healthcare Provider Details

I. General information

NPI: 1891976098
Provider Name (Legal Business Name): KRISTINE M PLEACHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102
US

IV. Provider business mailing address

301C US ROUTE ONE
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-2179
  • Fax: 207-662-6326
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number5887520-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number018927
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: