Healthcare Provider Details

I. General information

NPI: 1326009259
Provider Name (Legal Business Name): PATRICIA B STOGSDILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FODEN RD, STE 3
SOUTH PORTLAND ME
04106-1718
US

IV. Provider business mailing address

100 GANNETT DRIVE SUITE C
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-5816
  • Fax: 207-523-8594
Mailing address:
  • Phone: 207-523-3649
  • Fax: 207-874-1483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD13332
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD13332
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: