Individual
MR. BART JOSEPH DECRISTOFORO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A - C
Contact information
Practice address
66 BRAMHALL ST, SUITE G1, PORTLAND, ME 04102-3344
(207) 662-3157
(207) 662-6434
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-734
ME
Other
Enumeration date
04/06/2007
Last updated
04/25/2017
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