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General NPI Number Information
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NPI Number | 1508831900
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Entity Type | Individual
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Provider Name | KATHY A BUSH MD
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Gender | Female
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 100 FODEN ROAD WEST SUITE 100
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106
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Country | US
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Telephone | 207-523-3900
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Fax | 207-523-8593
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Provider Business Mailing Address
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Address Line | 100 FODEN RD WEST SUITE 203
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2327
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Country | US
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Telephone | 207-828-0361
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Fax | 207-874-1483
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2005-00586
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207NP0225X
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Taxonomy Name | Pediatric Dermatology Physician
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License Number | 2005-00586
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 2005-00586
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 017218
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License Number State | ME
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