Healthcare Provider Details

I. General information

NPI: 1649230269
Provider Name (Legal Business Name): KATHLEEN CLAIRE MORRIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 MAIN ST SUITE 1
SPRINGVALE ME
04083-1818
US

IV. Provider business mailing address

462 MAIN ST SUITE 1
SPRINGVALE ME
04083-1818
US

V. Phone/Fax

Practice location:
  • Phone: 207-206-7270
  • Fax: 207-206-7268
Mailing address:
  • Phone: 207-206-7270
  • Fax: 207-206-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number012728
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierE400170161
Identifier TypeOTHER
Identifier StateME
Identifier IssuerMEDICARE PTAN
# 2
Identifier26442099
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: