Healthcare Provider Details

I. General information

NPI: 1922437425
Provider Name (Legal Business Name): CENTRAL MAINE ORTHOPAEDICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 MINOT AVE
AUBURN ME
04210-3922
US

IV. Provider business mailing address

690 MINOT AVE
AUBURN ME
04210-3922
US

V. Phone/Fax

Practice location:
  • Phone: 207-783-1328
  • Fax: 207-786-4332
Mailing address:
  • Phone: 207-783-1328
  • Fax: 207-786-4332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateME

VIII. Authorized Official

Name: JANICE FOURNIER
Title or Position: CHIEF FINANCIAL AND ADMIN. OFFICER
Credential:
Phone: 207-344-2230