Individual
DR. MARY LARISSA WEIRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-0111
Mailing address
63 CUMBERLAND RD, SOUTH PORTLAND, ME 04106-6316
(503) 930-3413
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
94946
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/22/2019
Last updated
03/15/2023
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