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General NPI Number Information
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NPI Number | 1104870377
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Entity Type | Individual
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Provider Name | NANANDA F COL MD
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-4745
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Fax | 207-662-3110
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Provider Business Mailing Address
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Address Line | 39 FOREST AVE MAINE MEDICAL CENTER
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City | PORTLAND
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State | ME
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Zip | 04110
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Country | US
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Telephone | 207-662-4745
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 017686
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD11540
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License Number State | RI
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