Provider Demographics
NPI:1891866372
Name:HUOT, BRAD R (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:R
Last Name:HUOT
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:PO BOX 9746
Mailing Address - Street 2:MARTINS POINT HEALTHCARE
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-5040
Mailing Address - Country:US
Mailing Address - Phone:207-791-3888
Mailing Address - Fax:207-828-7850
Practice Address - Street 1:331 VERANDA ST
Practice Address - Street 2:MARTINS POINT HEALTHCARE
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5545
Practice Address - Country:US
Practice Address - Phone:207-791-3888
Practice Address - Fax:207-828-7850
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H83866Medicare UPIN
ME000288203Medicare PIN
MEP00751425Medicare PIN
NH30208325Medicaid
MEP00751425Medicare PIN