Individual
CECILIA K TRYDESTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
93 CAMPUS AVE I2 WING, LEWISTON, ME 04240
(207) 777-8650
(207) 777-8641
Mailing address
770 ROOSEVELT TRAIL, STE 8 #1015, N WINDHAM, ME 04062
(207) 717-9550
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD24297
ME
208600000X
Surgery Physician
MD60458584
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811121684
—
WA
01
—
P01625698
RR MEDICARE WVH
WA
Enumeration date
05/08/2009
Last updated
03/24/2025
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