Provider Demographics
NPI:1699129015
Name:CATHLEEN LONDON MD PA
Entity type:Organization
Organization Name:CATHLEEN LONDON MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-847-8020
Mailing Address - Street 1:26 BULLWINKLE DR
Mailing Address - Street 2:
Mailing Address - City:MILBRIDGE
Mailing Address - State:ME
Mailing Address - Zip Code:04658-3763
Mailing Address - Country:US
Mailing Address - Phone:207-847-8020
Mailing Address - Fax:207-850-2230
Practice Address - Street 1:26 BULLWINKLE DR
Practice Address - Street 2:
Practice Address - City:MILBRIDGE
Practice Address - State:ME
Practice Address - Zip Code:04658-3763
Practice Address - Country:US
Practice Address - Phone:207-847-8020
Practice Address - Fax:207-850-2230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20645261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service