Healthcare Provider Details

I. General information

NPI: 1861720906
Provider Name (Legal Business Name): CITY OF PORTLAND MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PORTLAND ST
PORTLAND ME
04101-2912
US

IV. Provider business mailing address

389 CONGRESS ST ROOM 307
PORTLAND ME
04101-3566
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8445
  • Fax:
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: MARK H REES
Title or Position: CITY MANAGER
Credential:
Phone: 207-874-8944