Healthcare Provider Details

I. General information

NPI: 1104385962
Provider Name (Legal Business Name): TESS C. WINTERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 MARGINAL WAY STE 800
PORTLAND ME
04101-2475
US

IV. Provider business mailing address

100 GANNETT DR STE C
SOUTH PORTLAND ME
04106-5900
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1489
  • Fax:
Mailing address:
  • Phone: 207-347-2947
  • Fax: 207-874-2317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD25925
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: