Individual
DR. JOHN LUKE PONTOLILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
489 STATE ST, BANGOR, ME 04401-6616
(207) 793-7000
Mailing address
324 GANNETT DR STE 200, SOUTH PORTLAND, ME 04106-3266
(207) 482-7800
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD24522
ME
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1790170926
—
ME
Enumeration date
04/03/2015
Last updated
05/07/2021
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