Healthcare Provider Details

I. General information

NPI: 1457362741
Provider Name (Legal Business Name): ALAN S HARMATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 10/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MAIN ST STE 302
LEWISTON ME
04240-7054
US

IV. Provider business mailing address

287 MAIN ST STE 302
LEWISTON ME
04240-7054
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-6543
  • Fax: 207-795-0488
Mailing address:
  • Phone: 207-795-6543
  • Fax: 207-795-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number013448
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: