Provider Demographics
NPI:1043257561
Name:PHILPOTT, ADI MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:ADI
Middle Name:MICHELLE
Last Name:PHILPOTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2512
Mailing Address - Country:US
Mailing Address - Phone:207-370-8045
Mailing Address - Fax:636-851-2820
Practice Address - Street 1:37 LEONARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2512
Practice Address - Country:US
Practice Address - Phone:207-370-8045
Practice Address - Fax:636-851-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1860204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H42004Medicare UPIN