Healthcare Provider Details

I. General information

NPI: 1780874883
Provider Name (Legal Business Name): KRISTINA A GILES-MAGNIFICO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA A GILES MD

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
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:
Mailing address:
  • Phone: 207-774-6368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number232850
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME120737
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD23932
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: