Provider Demographics
NPI:1356310098
Name:MURRAY PULSIFER, KRISTY (DO)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:
Last Name:MURRAY PULSIFER
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 1:100 FODEN ROAD WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:100 FODEN ROAD EAST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-874-1489
Practice Address - Fax:207-523-8590
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1042541OtherAETNA
MEP01120747OtherRR MEDICARE
018398OtherANTHEM
ME258960099Medicaid
MEP01120792OtherRR MEDICARE
MEMM499602Medicare PIN
MM4996Medicare ID - Type Unspecified
1042541OtherAETNA
MEP01120747OtherRR MEDICARE
ME258960099Medicaid