Individual
MARK GREGORY KIEFNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
26 PORTLAND STREET, PORTLAND, ME 04101
(207) 761-8402
(207) 761-8405
Mailing address
PO BOX 8600, PORTLAND, ME 04104
(207) 774-6323
(207) 761-8460
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
PS815
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010593
ANTHEM
ME
Enumeration date
05/16/2007
Last updated
07/08/2007
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