Healthcare Provider Details

I. General information

NPI: 1619075090
Provider Name (Legal Business Name): PORTLAND CARDIOLOGY P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 FOREST AVE
PORTLAND ME
04103-1884
US

IV. Provider business mailing address

1250 FOREST AVE
PORTLAND ME
04103-1884
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-5051
  • Fax:
Mailing address:
  • Phone: 207-878-5051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number993
License Number StateME

VIII. Authorized Official

Name: DR. CHARLES S HOAG
Title or Position: CARDIOLOGIST
Credential: D.O.
Phone: 207-878-5051