DR. MARY IACULLI


Address: 331 Veranda St, Portland, ME 04103-5545
Phone: 2078282402

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207QS0010X Family Medicine
Specialization: Sports Medicine
DO2695 ME Allopathic & Osteopathic Physicians

Provider Secondary Practice Location

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

Office Location

Street Address 331 VERANDA ST
City PORTLAND
State ME
Zip Code 04103-5545

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 207QS0010X
Grouping Allopathic & Osteopathic Physicians
Classification Family Medicine
Specialization Sports Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City PORTLAND
Zip Code 04103

Improve Information

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Dataset Information

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.

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