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1952892978
CODY BOTHEL
PORTLAND, ME
NPI
1952892978
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: ME PA1793)
Enumeration Date
2018-05-24
Last Update Date
2018-09-21
Business Address
CODY BOTHEL PA-C
33 SEWALL ST
PORTLAND, ME 04102-2603
Phone number: 207-272-2734
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Mailing Address
CODY BOTHEL PA-C
324 GANNETT DR STE 200
SOUTH PORTLAND, ME 04106-3266
Phone number: 207-482-7800
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