Healthcare Provider Details

I. General information

NPI: 1760628358
Provider Name (Legal Business Name): MARITIME RADIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2009
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 E MAIN ST
FORT KENT ME
04743-1428
US

IV. Provider business mailing address

251 NAJOLES RD STE A
MILLERSVILLE MD
21108-2519
US

V. Phone/Fax

Practice location:
  • Phone: 207-834-3155
  • Fax: 443-274-2589
Mailing address:
  • Phone: 443-274-2888
  • Fax: 443-274-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLAUCO MICHAEL MARESCA
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 315-265-4924