Healthcare Provider Details

I. General information

NPI: 1043224330
Provider Name (Legal Business Name): MID-MAINE INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 MAIN STREET
NORTH VASSALBORO ME
04962
US

IV. Provider business mailing address

PO BOX 247
N VASSALBORO ME
04962-0247
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-6173
  • Fax: 207-873-4514
Mailing address:
  • Phone: 207-873-6173
  • Fax: 207-873-4514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN E BURKE
Title or Position: PRESIDENT
Credential: MD
Phone: 207-873-6173