Healthcare Provider Details

I. General information

NPI: 1780674689
Provider Name (Legal Business Name): EASTERN MAINE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

43 WHITING HILL RD FLOOR 5
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number35999
License Number StateME

VIII. Authorized Official

Name: MR. MARC EDELMAN
Title or Position: SR. VP OF OPERATIONS
Credential:
Phone: 207-973-8992