Provider Demographics
NPI:1619364999
Name:BAIR, KISSONIE SANSHIA MCDONALD (MD)
Entity Type:Individual
Prefix:
First Name:KISSONIE
Middle Name:SANSHIA MCDONALD
Last Name:BAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:197 E MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1409
Mailing Address - Country:US
Mailing Address - Phone:072-834-6784
Mailing Address - Fax:207-834-2967
Practice Address - Street 1:197 E MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1409
Practice Address - Country:US
Practice Address - Phone:207-834-6784
Practice Address - Fax:207-834-2967
Is Sole Proprietor?:No
Enumeration Date:2015-04-23
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD22350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine