Provider Demographics
NPI:1225869696
Name:ENGELMAN, IAN KENTON (MS CPO)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:KENTON
Last Name:ENGELMAN
Suffix:
Gender:M
Credentials:MS CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 US ROUTE 1 STE 2-SOUTH
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1350
Mailing Address - Country:US
Mailing Address - Phone:207-430-1014
Mailing Address - Fax:
Practice Address - Street 1:367 US ROUTE 1 STE 2-SOUTH
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1350
Practice Address - Country:US
Practice Address - Phone:207-430-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier