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Organization
PORTLAND WEST FAMILY PRACTICE, LLC
Active
Organization
PORTLAND WEST FAMILY PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE D BLAKE DO (PARTNER)
(207) 856-6792
Entity
Organization
Contact information
Practice address
114 STROUDWATER ST, WESTBROOK, ME 04092-4037
(207) 856-6792
(207) 854-1146
Mailing address
114 STROUDWATER ST, WESTBROOK, ME 04092-4037
(207) 856-6792
(207) 854-1146
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
—
ME
207Q00000X
Family Medicine Physician
Primary
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
409080000
—
ME
Enumeration date
01/09/2007
Last updated
10/06/2016
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