Healthcare Provider Details

I. General information

NPI: 1437485117
Provider Name (Legal Business Name): CITY OF PORTLAND MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 INDIA ST
PORTLAND ME
04101-4211
US

IV. Provider business mailing address

389 CONGRESS ST ROOM 307
PORTLAND ME
04101-3566
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8446
  • Fax: 207-756-8087
Mailing address:
  • Phone: 207-874-8784
  • Fax: 207-874-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JON P. JENNINGS
Title or Position: CITY MANAGER
Credential:
Phone: 207-874-8944