100 Foden Rd, West, Ste 203, South Portland, Me 04106, ME 04106
Phone
(207) 523-3900
Listed under
Individual clinicians
NPI
1528323698
NPI status
Active in the NPPES registry
Provider type
Individual provider
Registered specialty (self-reported taxonomy)
Dermatology (207N00000X)
Credentials listed
MD
License number on NPI record
MD24972 (ME)
NPI first issued
Jul 5, 2012
Years since NPI first issued
14 years (since 2012)
License state on NPI record
ME
NPI record last updated
Mar 3, 2026
Medicare enrollment (CMS)
Enrolled: listed in CMS Doctors & Clinicians
Medicare assignment (CMS)
Accepts the Medicare-approved amount as payment in full
Professional school graduation (CMS)
2012 (14 years ago)
Professional school (CMS)
University of Vermont College of Medicine
Medicare group practice (CMS)
Intermed PA (183 clinicians)
Practice locations on file with Medicare (CMS)
2
Other dermatology listings at this street address
2
NPI 1528323698 is active in the federal NPPES registry (CMS) with Dermatology as its self-reported primary taxonomy; license MD24972 (ME) is listed on the record. CMS Doctors & Clinicians lists this clinician as enrolled in Medicare. Source: NPPES NPI Registry (CMS) (record). Data as of 2026-10-16.
Public record, not an endorsement. This listing was compiled from public records as of 2026-10-16 and may be incomplete or out of date. Dermatologist Index does not vet, employ, recommend or guarantee dermatology practices; a badge reflects only what the public record showed on that date. Confirm current details with the official record before you decide. The information on Dermatologist Index is not medical advice and does not replace a doctor, nurse, discharge planner or other qualified professional. Do not use it to make decisions about diagnosis or treatment. If you have a medical emergency, call 911. Full disclaimer · Report an error
What these registry facts mean
The NPI (National Provider Identifier) is the federal ID every HIPAA-covered provider uses to bill insurance. This NPI belongs to an individual clinician. The specialty is the taxonomy the provider chose when registering; NPPES does not check it. A license number here is what the provider entered — confirm it with the state board before you rely on it. A registered specialty is not board certification. To check board certification, use the American Board of Dermatology's verification tool (or the American Osteopathic Board of Dermatology for DOs), and confirm the medical license with the state board.
Other listings in this directory whose NPI record gives the same street address and ZIP. A shared address usually means a shared practice or building; it does not by itself show who works with whom.
Registered specialty is not board certification. Verify the license with the state medical board and board certification with the American Board of Dermatology or the American Osteopathic Board of Dermatology. Ask whether the practice takes your insurance or Medicare plan before you book.