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General NPI Number Information
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NPI Number | 1386030369
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Entity Type | Individual
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Provider Name | KATHLEEN ROOT MD
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Gender | Female
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 181 MAIN ST
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City | NORWAY
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State | ME
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Zip | 04268
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Country | US
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Telephone | 207-543-5933
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Fax |
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Provider Business Mailing Address
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Address Line | 181 MAIN ST
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City | NORWAY
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State | ME
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Zip | 04268-5664
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD22393
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License Number State | ME
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