Individual
JOHN MLADUCKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
300 MAIN ST, LEWISTON, ME 04240-7027
(207) 795-0111
Mailing address
56 PENNELL AVE, PORTLAND, ME 04103-2076
(920) 288-1384
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
PA1957
ME
208D00000X
General Practice Physician
PA1957
ME
208M00000X
Hospitalist Physician
PA1957
ME
Other
Enumeration date
06/01/2019
Last updated
01/04/2024
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