Provider Demographics
NPI:1255493524
Name:OSWALD, KURT MARTIN (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:MARTIN
Last Name:OSWALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 GOFF ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5024
Mailing Address - Country:US
Mailing Address - Phone:207-784-3000
Mailing Address - Fax:207-782-4821
Practice Address - Street 1:117 GOFF ST
Practice Address - Street 2:SUITE 1
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5024
Practice Address - Country:US
Practice Address - Phone:207-784-3000
Practice Address - Fax:207-782-4821
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME012320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME22948000Medicaid
E88448Medicare UPIN
MM1118Medicare ID - Type Unspecified