Healthcare Provider Details

I. General information

NPI: 1659337905
Provider Name (Legal Business Name): MAINEGENERAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 DRESDEN AVE
GARDINER ME
04345-2615
US

IV. Provider business mailing address

150 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-7478
  • Fax:
Mailing address:
  • Phone: 207-621-9337
  • Fax: 207-621-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberNOT APPLICABLE
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberNOT APPLICABLE
License Number StateME

VIII. Authorized Official

Name: BARBARA A CROWLEY
Title or Position: PRESIDENT, MGHA
Credential: MD
Phone: 207-626-1063