Healthcare Provider Details

I. General information

NPI: 1982965794
Provider Name (Legal Business Name): CHRISTINA HAMMOND VIETOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD, EAST SUITE 203
SOUTH PORTLAND ME
04106-1316
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 207-874-1489
  • Fax: 207-523-8590
Mailing address:
  • Phone: 207-828-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60562552
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2610
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: