Healthcare Provider Details

I. General information

NPI: 1548203334
Provider Name (Legal Business Name): STEPHEN Z HULL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CONGRESS ST UNIT 3
PORTLAND ME
04102-2119
US

IV. Provider business mailing address

144 STATE ST
PORTLAND ME
04101-3776
US

V. Phone/Fax

Practice location:
  • Phone: 207-400-5833
  • Fax: 207-400-8560
Mailing address:
  • Phone: 207-879-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number011477
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: