Graduated: 2025
NPI: 1063393387
Practice Locations (3)
PO BOX
LEWISTON, ME 04243
15 GRUMMAN RD W, SUITE 1400
Bethpage, NY 117145029
200 W MARTIN LUTHER KING BLVD, SUITE 1000
CHATTANOOGA, TN 374022571
Source: CMS National Downloadable File, September 2026.