Individual
DR. MARY IACULLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
331 VERANDA ST, PORTLAND, ME 04103-5545
(207) 828-2402
Mailing address
PO BOX 9746, PORTLAND, ME 04104-5040
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
DO2695
ME
Other
Enumeration date
05/07/2014
Last updated
10/02/2020
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