Individual
DR. PETER M MIRKIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
477 CONGRESS ST, 5TH FLOOR, PORTLAND, ME 04101-3427
(207) 329-1553
Mailing address
15 PHINNEY ST, GORHAM, ME 04038-2061
(207) 329-1553
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
014555
ME
2084P0800X
Psychiatry Physician
020367
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
014555
MAINE STATE LICENSE
ME
01
—
020367
CONNECTICUT STATE LICENSE
CT
Enumeration date
07/27/2009
Last updated
03/07/2023
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