Individual
IRA W. STOCKWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
344 CUMBERLAND ST, WESTBROOK, ME 04092-2408
(207) 854-8200
(207) 854-8200
Mailing address
2 CHABOT ST, STE 2, WESTBROOK, ME 04092-4815
(207) 857-9311
(207) 857-9324
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
DO847
ME
208D00000X
General Practice Physician
847
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199930099
—
ME
Enumeration date
06/21/2006
Last updated
06/13/2019
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