Provider Demographics
NPI:1417923947
Name:KAMMERER, KIERAN G (MD)
Entity Type:Individual
Prefix:
First Name:KIERAN
Middle Name:G
Last Name:KAMMERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5758
Mailing Address - Country:US
Mailing Address - Phone:207-623-2977
Mailing Address - Fax:207-626-9374
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-623-2977
Practice Address - Fax:207-626-9374
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME292020099Medicaid
MEMM867502Medicare PIN
MEF84165Medicare UPIN
MEMM8675Medicare ID - Type Unspecified
MEMM867501Medicare PIN