Healthcare Provider Details

I. General information

NPI: 1952862815
Provider Name (Legal Business Name): THOMAS MICHAEL KUCZMARSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 06/09/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 WESTERN AVE STE 2
SOUTH PORTLAND ME
04106-2458
US

IV. Provider business mailing address

265 WESTERN AVE STE 2
SOUTH PORTLAND ME
04106-2458
US

V. Phone/Fax

Practice location:
  • Phone: 207-661-0200
  • Fax: 207-661-0299
Mailing address:
  • Phone: 207-661-0200
  • Fax: 207-661-0299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD29424
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD29424
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: