=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952520694
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NICOLAS FLANNERY ARREDONDO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 02/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 195 FORE RIVER PKWY STE 440
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-2788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-553-6054
-----------------------------------------------------
Fax | 207-553-6076
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 FORE RIVER PKWY STE 440
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04102-2788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 72-553-6054
-----------------------------------------------------
Fax | 207-553-6076
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | MD21958
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------