Healthcare Provider Details

I. General information

NPI: 1679539167
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: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 OLD BELGRADE RD ALFOND CANCER CENTER
AUGUSTA ME
04330-8058
US

IV. Provider business mailing address

150 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-621-6100
  • Fax: 207-621-6102
Mailing address:
  • Phone: 207-621-9337
  • Fax: 207-621-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A CROWLEY
Title or Position: PRESIDENT, MGHA
Credential: MD
Phone: 207-626-1063