Healthcare Provider Details

I. General information

NPI: 1942973474
Provider Name (Legal Business Name): MAEGAN A MAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 S MAIN ST STE 110
BREWER ME
04412-2440
US

IV. Provider business mailing address

814 FULLER RD
HERMON ME
04401-0108
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-0492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCNP211256
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: