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General NPI Number Information
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NPI Number | 1104910926
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Entity Type | Organization
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Legal Business Name | COASTAL MAINE FOOT & ANKLE CENTER PLLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/14/2007
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Provider Practice Location Address
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Address Line | 21 NORTHBROOK DR SUITE B
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City | FALMOUTH
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State | ME
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Zip | 04105-1346
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Country | US
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Telephone | 207-781-7715
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Fax | 207-781-5715
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Provider Business Mailing Address
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Address Line | PO BOX 2200
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City | AMHERST
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State | NH
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Zip | 03031-4200
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Country | US
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Telephone | 207-781-7715
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Fax | 207-781-5715
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON MEREDITH
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Credential | DPM
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Telephone | 207-781-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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