Healthcare Provider Details

I. General information

NPI: 1134440803
Provider Name (Legal Business Name): NICHOLAS PIOTROWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 ATLANTIC PL
SOUTH PORTLAND ME
04106-2316
US

IV. Provider business mailing address

78 ATLANTIC PL
SOUTH PORTLAND ME
04106-2316
US

V. Phone/Fax

Practice location:
  • Phone: 844-292-0111
  • Fax:
Mailing address:
  • Phone: 844-292-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01076789A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD23611
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: