Individual
POONAM KHADKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
900 BROADWAY, BANGOR, ME 04401-1900
(207) 907-1187
(207) 907-1189
Mailing address
C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT, PO BOX 7291, LEWISTON, ME 04243-7291
(207) 777-8560
(207) 777-8800
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
MD20656
ME
Other
Enumeration date
01/22/2012
Last updated
02/03/2022
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