Provider Demographics
NPI:1104400621
Name:PORTLAND PAIN SOLUTIONS LLC
Entity Type:Organization
Organization Name:PORTLAND PAIN SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:LITTLEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-631-3194
Mailing Address - Street 1:25 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-8442
Mailing Address - Country:US
Mailing Address - Phone:207-835-8116
Mailing Address - Fax:
Practice Address - Street 1:1945 CONGRESS ST STE 103
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1967
Practice Address - Country:US
Practice Address - Phone:207-835-8116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain