Provider Demographics
NPI:1881669836
Name:DESENA, DANFORTH S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANFORTH
Middle Name:S
Last Name:DESENA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MARGINAL WAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2444
Mailing Address - Country:US
Mailing Address - Phone:207-879-1339
Mailing Address - Fax:207-879-1092
Practice Address - Street 1:68 MARGINAL WAY
Practice Address - Street 2:4TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2444
Practice Address - Country:US
Practice Address - Phone:207-879-1339
Practice Address - Fax:207-879-1092
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD170213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME114830099Medicaid
ME015411Medicare ID - Type UnspecifiedDANFORTH DESENA, D.P.M.
ME114830099Medicaid