Healthcare Provider Details

I. General information

NPI: 1437160918
Provider Name (Legal Business Name): MAINE INTERVENTIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 MEDICAL CENTER DR
BRUNSWICK ME
04011-2652
US

IV. Provider business mailing address

PO BOX 1849
LEWISTON ME
04241-1849
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-2554
  • Fax: 207-777-1439
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-1439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN J CHOMYN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-784-2554