Individual
DR. BRIAN J KEROACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 774-5761
(207) 874-7478
Mailing address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 774-5761
(207) 874-7478
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
013245
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0673610001
DMERC
ME
05
—
269530099
—
ME
01
—
660000685
PALMETTO RAILROAD MEDICARE
ME
Enumeration date
08/26/2005
Last updated
10/09/2008
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