DR. MARY IACULLI (NPI# 1407266778) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1407266778 |
Entity Type | Individual |
Full Name | DR. MARY IACULLI |
Credential | D.O. |
Practice Address |
331 Veranda St Portland ME 04103-5545 |
Mailing Address |
Po Box 9746 Portland ME 04104-5040 |
Practice Telephone | 2078282402 |
Enumeration Date | 2014-05-07 |
Last Update Date | 2020-10-02 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
DO2695 | ME | Allopathic & Osteopathic Physicians |
Address | Telephone Number | Fax Number |
---|---|---|
1 Boston Medical Ctr Pl, Boston Medical Center, Boston, MA 021182908 | 5857384986 | |
15 E Chestnut St, Augusta, ME 043305736 | 2076236663 | |
77 Bates St Ste 201, Lewiston, ME 042407637 | 2077958465 |
Street Address |
331 VERANDA ST |
City | PORTLAND |
State | ME |
Zip Code | 04103-5545 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023014198 | Linda K Morrison | Ophthalmology | 331 Veranda St, Portland, ME 04103-5545 | 2005-06-23 |
1326561564 | Katherine Smith | Nurse Practitioner | 331 Veranda St, Portland, ME 04103-5545 | 2017-07-19 |
1609304658 | Jessica B Mcconville | Nurse Practitioner | 331 Veranda St, Portland, ME 04103-5545 | 2017-06-02 |
1598298697 | Kristen Lang | Family Medicine | 331 Veranda St, Portland, ME 04103-5545 | 2017-04-05 |
1104369164 | Kimberly Wallingford Macvane | Physical Therapist | 331 Veranda St, Building 6, Rm 3311, Portland, ME 04103-5545 | 2016-11-23 |
1972974434 | Ashley Vadas | Social Worker | 331 Veranda St, Bldg. 6, Portland, ME 04103-5545 | 2015-10-09 |
1902274541 | Alliance Physical Therapy, LLC | Physical Therapist | 331 Veranda St, Building 6, Rm 3311, Portland, ME 04103-5545 | 2015-09-14 |
1780052795 | Austin Cary Stonebraker | Physical Therapist | 331 Veranda St, Building 6, Room 3311, Portland, ME 04103-5545 | 2015-09-08 |
1043688039 | Pinnacle Rehabilitation Network LLC | Physical Therapist | 331 Veranda St, Building 6, Room 3311, Portland, ME 04103-5545 | 2015-09-08 |
1114308277 | James Mcilhenny Riddleberger | Family Medicine | 331 Veranda St, Portland, ME 04103 | 2015-06-15 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1790302677 | Hope for All Community Services LLC | Community/Behavioral Health | 68 Bishop St, Building 1, Unit 1, Portland, ME 04103 | 2020-06-26 |
1982251435 | Hope Home Healthcare, LLC | Home Health | 68 Bishop St Unit 3 #2, Portland, ME 04103 | 2019-08-20 |
1992367023 | Care for Everyone | In Home Supportive Care | 68 Bishop Street, Unit 1, Room 5, Portland, ME 04103 | 2019-06-28 |
1093373458 | Emanuel Nistrian | Student in an Organized Health Care Education/Training Program | Une, 716 Stevens Ave., Portland, ME 04103 | 2019-05-31 |
1023676483 | Robert Montague | Student in an Organized Health Care Education/Training Program | University of New England, 716 Stevens Ave, Portland, ME 04103 | 2019-05-31 |
1154838027 | Kimberly Therriault | Behavior Technician | 527 Ocean Ave Ste 19, Portland, ME 04103 | 2018-01-02 |
1285147918 | Teresa Maalouf | Community Health Worker | 23 Cambridge St., Portland, ME 04103 | 2017-11-16 |
1578082244 | Darcelle Kay Stillman | Occupational Therapist | 90 Dorothy St, Portland, ME 04103 | 2017-09-14 |
1821524943 | Engility Enterprises LLC | Case Management | 1 Coast Lane, Portland, ME 04103 | 2017-05-10 |
1720524283 | Hannah Rose Kazilionis | Counselor | 257 Deering Ave # 204, Portland, ME 04103 | 2017-01-09 |
Find all providers in zip 04103 |
Taxonomy Code | 207QS0010X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Family Medicine |
Specialization | Sports Medicine |
A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801079074 | Jennifer Dawn Kleinman | Family Medicine | 5704 N Montana Ave, Portland, OR 97217-4643 | 2007-12-11 |
1871558353 | Douglas Bruce Mckeag | Family Medicine | 4411 Sw Vermont St, Portland, OR 97219-1020 | 2006-04-19 |
1356305023 | David N Westerdahl | Family Medicine | 12672 Nw Barnes Rd Ste 100, Portland, OR 97229-6191 | 2006-04-12 |
1396739520 | William W Dexter | Family Medicine | 272 Congress St, Portland, ME 04102 | 2005-09-02 |
1346863727 | Sports Health Northwest Inc | Family Medicine | 12672 Nw Barnes Rd Ste 100, Portland, OR 97229-6191 | 2020-05-20 |
1518347897 | James Suchy | Family Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3079 | 2015-06-02 |
1508278904 | James Alex | Family Medicine | 22 Bramhall St, Portland, ME 04102-3134 | 2014-05-20 |
1114213667 | Alison Savage Lee | Family Medicine | 33 Sewall St, Portland, ME 04102-2603 | 2011-06-23 |
1952575391 | Melissa A. Novak | Family Medicine | 4411 Sw Vermont St, Gabriel Park Family Health Center, Portland, OR 97219-1020 | 2008-04-16 |
1174793301 | Ryan Carl Petering | Family Medicine | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2008-03-04 |
Find all providers in PORTLAND |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.