Provider Demographics
NPI:1386755643
Name:QUIJANO, MARTA AGLAEE (MD)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:AGLAEE
Last Name:QUIJANO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:144 STATE ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3776
Mailing Address - Country:US
Mailing Address - Phone:207-553-6800
Mailing Address - Fax:207-553-6810
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6800
Practice Address - Fax:207-553-6810
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-02-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME017538208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME000040301Medicare PIN
OR148308Medicare UPIN