Healthcare Provider Details

I. General information

NPI: 1144209123
Provider Name (Legal Business Name): CHRISTOPHER J DELORIE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 11/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 US ROUTE 1 UNIT 9
YORK ME
03909
US

IV. Provider business mailing address

519 US ROUTE 1 UNIT 9
YORK ME
03909
US

V. Phone/Fax

Practice location:
  • Phone: 207-363-4114
  • Fax: 207-363-4126
Mailing address:
  • Phone: 207-363-4114
  • Fax: 207-363-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number1853
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: