Individual
PREMALATHA BABU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 FODEN RD, PORTLAND, ME 04106-2327
(207) 874-1489
Mailing address
100 GANNETT DR STE C, SOUTH PORTLAND, ME 04106-5900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD28276
ME
390200000X
Student in an Organized Health Care Education/Training Program
390200000X
GA
Other
Enumeration date
03/20/2021
Last updated
10/28/2024
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