1780659722 NPI number — DR. KENNETH PAUL FLANIGAN III D.P.M.

Table of content: DR. KENNETH PAUL FLANIGAN III D.P.M. (NPI 1780659722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780659722 NPI number — DR. KENNETH PAUL FLANIGAN III D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANIGAN
Provider First Name:
KENNETH
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780659722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
68 MARGINAL WAY
Provider Second Line Business Mailing Address:
4TH FLOOR
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-2444
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-879-1339
Provider Business Mailing Address Fax Number:
207-879-1092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
68 MARGINAL WAY
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-2444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-879-1339
Provider Business Practice Location Address Fax Number:
207-879-1092
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  POD1033 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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