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NPI Code Detail

MEDICARE: INTERMED, PA

MEDICARE: INTERMED, PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician
2208000000XPediatrics Physician
3208600000XSurgery Physician
4207Q00000XFamily Medicine Physician
52084P0800XPsychiatry Physician
6207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1336538198
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMED, PA
Provider Business Mailing Address
First Line : 100 GANNETT DR
Second Line : SUITE C
City : SOUTH PORTLAND
State : ME
Zip : 04106-5900
Country : US
Telephone Number : 207-247-2947
Fax Number : 207-874-2317
Provider Business Practice Location Address
First Line : 84 MARGINAL WAY
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2443
Country : US
Telephone Number : 207-774-5816
Fax Number : 855-576-4814
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : ROGER A. POITRAS
Credential :
Telephone Number : 207-347-2853
Provider Enumeration Date : 01/16/2015
Last Update Date : 05/12/2026

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Directions to “INTERMED, PA ” Practice Location

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