Healthcare Provider Details

I. General information

NPI: 1104400621
Provider Name (Legal Business Name): PORTLAND PAIN SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 CONGRESS ST STE 103
PORTLAND ME
04102-1967
US

IV. Provider business mailing address

25 CHESTNUT LN
YARMOUTH ME
04096-8442
US

V. Phone/Fax

Practice location:
  • Phone: 207-835-8116
  • Fax:
Mailing address:
  • Phone: 207-835-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDERICK CRAIG LITTLEJOHN
Title or Position: PRESIDENT
Credential: MD
Phone: 207-631-3194