Individual
DR. JONATHAN AMATRUDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1600 CONGRESS ST STE B, PORTLAND, ME 04102-2148
(207) 774-5222
Mailing address
1600 CONGRESS ST STE B, PORTLAND, ME 04102-2148
(207) 774-5222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A155033
CA
207RN0300X
Nephrology Physician
A155033
CA
207RN0300X
Nephrology Physician
Primary
MD28202
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264157
LICENSE #
MA
Enumeration date
06/05/2015
Last updated
07/09/2024
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