Individual
LAURA J. FAHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H., M.S.H.
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-2911
(617) 568-4780
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-2911
(617) 568-4780
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD23809
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110095957A
—
MA
Enumeration date
03/25/2010
Last updated
10/18/2021
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