Healthcare Provider Details

I. General information

NPI: 1770218869
Provider Name (Legal Business Name): KARL JOSEPH HURTUBISE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102-3175
US

IV. Provider business mailing address

22 LONGVIEW TER
KENNEBUNK ME
04043-6723
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-2087
  • Fax:
Mailing address:
  • Phone: 207-408-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2385
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: