Healthcare Provider Details

I. General information

NPI: 1598948283
Provider Name (Legal Business Name): OTOLARYNGOLOGY ASSOCIATES LLC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BATES ST
LEWISTON ME
04240-7675
US

IV. Provider business mailing address

PO BOX 1288
LEWISTON ME
04243-1288
US

V. Phone/Fax

Practice location:
  • Phone: 207-784-4539
  • Fax: 207-784-2868
Mailing address:
  • Phone: 207-784-4539
  • Fax: 207-784-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANITA J MAHEUX
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-784-4539