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General NPI Number Information
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NPI Number | 1033182019
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Entity Type | Individual
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Provider Name | GEORGE RICHARD POLKINGHORN MD
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Gender | Male
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Dates
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Enumeration Date | 02/09/2006
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 81 MEDICAL CENTER DR SUITE 1300
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City | BRUNSWICK
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State | ME
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Zip | 04011-2690
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Country | US
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Telephone | 207-729-1148
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Fax | 207-729-2789
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Provider Business Mailing Address
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Address Line | PO BOX 911
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City | BRATTLEBORO
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State | VT
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Zip | 05302-0911
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Country | US
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Telephone | 207-885-7601
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Fax | 207-885-7610
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 14286
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License Number State | ME
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