Healthcare Provider Details

I. General information

NPI: 1629382601
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BUCKNAM RD SUITE 1D
FALMOUTH ME
04105
US

IV. Provider business mailing address

22 BRAMHALL ST
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-781-1775
  • Fax: 207-781-1780
Mailing address:
  • Phone: 207-662-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number37563
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: SVP FINANCE/CFO
Credential:
Phone: 207-662-3538