Basic Information
| Provider Information | |||||||||
| NPI: | 1730255621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KITTERY FAMILY PRACTICE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 SHAPLEIGH RD | ||||||||
| Address2: | |||||||||
| City: | KITTERY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 039041455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074394430 | ||||||||
| FaxNumber: | 2074390968 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 SHAPLEIGH ROAD | ||||||||
| Address2: | |||||||||
| City: | KITTERY | ||||||||
| State: | ME | ||||||||
| PostalCode: | 03904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074394430 | ||||||||
| FaxNumber: | 2074390968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 01/31/2008 | ||||||||
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| AuthorizedOfficialLastName: | MCABEE | ||||||||
| AuthorizedOfficialFirstName: | EDWARD | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2074394430 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.