Individual
COSMINA I FACHIOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 973-7000
(207) 973-5042
Mailing address
43 WHITING HILL RD, STE 300, BREWER, ME 04412-1005
(207) 973-5035
(207) 973-5042
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD18653
ME
207QG0300X
Geriatric Medicine (Family Medicine) Physician
MD18653
ME
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
Primary
MD18653
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386761567
—
ME
05
—
434739399
—
ME
Enumeration date
03/23/2007
Last updated
01/17/2014
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