Healthcare Provider Details

I. General information

NPI: 1730591074
Provider Name (Legal Business Name): INA ST. ONGE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST STE 300
PORTLAND ME
04102-3103
US

IV. Provider business mailing address

887 CONGRESS ST STE 300
PORTLAND ME
04102-3103
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5522
  • Fax:
Mailing address:
  • Phone: 207-662-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberDO3669
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: