Healthcare Provider Details

I. General information

NPI: 1356446207
Provider Name (Legal Business Name): RADIATION PHYSICIANS OF CENTRAL MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST DEPARTMENT OF RADIATION ONCOLOGY
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

300 MAIN ST DEPARTMENT OF RADIATION ONCOLOGY
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-2440
  • Fax: 207-795-2444
Mailing address:
  • Phone: 207-795-2440
  • Fax: 207-795-2444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberNA
License Number State

VIII. Authorized Official

Name: DR. SUE A MANDELL
Title or Position: PRESIDENT
Credential: MD
Phone: 207-795-2440