Healthcare Provider Details

I. General information

NPI: 1164685749
Provider Name (Legal Business Name): KRISTINA WONG BERMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 08/14/2025
Certification Date: 08/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST STE 400
PORTLAND ME
04102-3163
US

IV. Provider business mailing address

887 CONGRESS ST STE 400
PORTLAND ME
04102-3163
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-6368
  • Fax: 207-774-9388
Mailing address:
  • Phone: 207-774-6368
  • Fax: 207-774-9388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number52918
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD29501
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number52918
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number24064
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number52918
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberMD29501
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: