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General NPI Number Information
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NPI Number | 1003086109
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Entity Type | Individual
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Provider Name | GORDON ADAIR HEATH M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 03/04/2008
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Provider Practice Location Address
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Address Line | 96 OCEAN ST UNIT 4
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2855
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Country | US
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Telephone | 207-221-3459
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Fax |
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Provider Business Mailing Address
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Address Line | 96 OCEAN ST UNIT 4
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2855
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Country | US
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Telephone | 207-221-3459
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 006396
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License Number State | ME
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