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General NPI Number Information
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NPI Number | 1518114149
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Entity Type | Individual
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Provider Name | NOAH P DIMINICK MD
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Gender | Male
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 06/04/2014
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Provider Practice Location Address
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Address Line | 22 BRAMHALL STREET
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City | PORTLAND
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State | ME
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Zip | 04102
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Country | US
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Telephone | 207-662-2541
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Fax | 412-692-7038
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Provider Business Mailing Address
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Address Line | 301C US ROUTE ONE
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City | SCARBOROUGH
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State | ME
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Zip | 04074
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT193169
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD442713
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD20138
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License Number State | ME
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