Individual
BAIRD MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
887 CONGRESS ST, SUITE 300, PORTLAND, ME 04102
(207) 662-5555
(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
2086S0120X
Pediatric Surgery Physician
Primary
016846
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431803499
—
ME
Enumeration date
06/13/2005
Last updated
01/05/2012
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