Healthcare Provider Details

I. General information

NPI: 1336145200
Provider Name (Legal Business Name): NORTHEAST NEPHROLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 STATE ST STE 321
BANGOR ME
04401-6638
US

IV. Provider business mailing address

417 STATE ST STE 321
BANGOR ME
04401-6638
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-8833
  • Fax: 207-973-8836
Mailing address:
  • Phone: 207-973-8833
  • Fax: 207-973-8836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN G COMEAU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-973-8833