Healthcare Provider Details

I. General information

NPI: 1538125034
Provider Name (Legal Business Name): MAINEGENERAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GLENDRIDGE DR
AUGUSTA ME
04330
US

IV. Provider business mailing address

150 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-2600
  • Fax: 207-621-0277
Mailing address:
  • Phone: 207-621-9337
  • Fax: 207-621-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A CROWLEY
Title or Position: PHYSICIAN NETWORK COORDINATOR
Credential: MD
Phone: 207-626-1063