Healthcare Provider Details

I. General information

NPI: 1356676688
Provider Name (Legal Business Name): CENTRAL MAINE CLINICAL ASSOCIATES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2009
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 MAIN STREET
LEWISTON ME
04240
US

IV. Provider business mailing address

364 MAIN STREET
LEWISTON ME
04240
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5709
  • Fax: 207-795-7193
Mailing address:
  • Phone: 207-795-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN MORIN
Title or Position: MANAGER
Credential:
Phone: 207-795-5709