Healthcare Provider Details

I. General information

NPI: 1841221629
Provider Name (Legal Business Name): TINA PIRAINO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

IV. Provider business mailing address

39 WALLACE AVE
SOUTH PORTLAND ME
04106-6143
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-4618
  • Fax: 207-662-6254
Mailing address:
  • Phone: 207-761-0650
  • Fax: 207-761-8198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1541
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1541
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: