Healthcare Provider Details

I. General information

NPI: 1841270535
Provider Name (Legal Business Name): CRAIG M BRETT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STATE ST
PORTLAND ME
04101-3776
US

IV. Provider business mailing address

144 STATE ST MERCY CARDIOLOGY
PORTLAND ME
04101
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-3770
  • Fax:
Mailing address:
  • Phone: 207-879-3770
  • Fax: 207-879-3707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number013654
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: