Individual
MARK J INTEGLIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
887 CONGRESS ST, SUITE 410B, PORTLAND, ME 04102-3100
(207) 662-5522
(207) 662-5526
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
015427
ME
2080P0206X
Pediatric Gastroenterology Physician
Primary
015427
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
283380099
—
ME
05
—
30201387
—
NH
Enumeration date
07/06/2006
Last updated
01/10/2011
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