Active NPI
Theresa T Kudlak, M.D.
- Anesthesiology Physician
- Portland, ME
National Provider Identifier
1841362068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD13466
- Practice address
- 22 Bramhall St
Portland, ME 04102-3134 - Phone
- (207) 662-2526
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD13466 | ME | Primary |
Addresses
Primary practice location
22 Bramhall St
Portland, ME 04102-3134
Mailing address
324 Gannett Dr Ste 200
South Portland, ME 04106-3266
Phone (207) 482-7800
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD13466 | ME | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446163200000",
"number": "1841362068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "324 GANNETT DR STE 200",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063266",
"telephone_number": "207-482-7800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 BRAMHALL ST",
"city": "PORTLAND",
"state": "ME",
"postal_code": "041023134",
"telephone_number": "207-662-2526"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUDLAK",
"first_name": "THERESA",
"middle_name": "T",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-14",
"last_updated": "2015-10-30",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "ME",
"license": "MD13466",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.