Provider Demographics
NPI:1366449258
Name:KENTOPP, KRISTIN E (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:E
Last Name:KENTOPP
Suffix:
Gender:F
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:P.O. BOX 745
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553-0745
Mailing Address - Country:US
Mailing Address - Phone:207-563-4146
Mailing Address - Fax:207-563-4103
Practice Address - Street 1:5 MILES CENTER WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4047
Practice Address - Country:US
Practice Address - Phone:207-563-4250
Practice Address - Fax:207-563-4561
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME312650099Medicaid
MEMM6730Medicare PIN
MM6730Medicare PIN
ME312650099Medicaid