Healthcare Provider Details

I. General information

NPI: 1043424344
Provider Name (Legal Business Name): MAINE NEPHROLOGY ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 02/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600B CONGRESS ST
PORTLAND ME
04102-2124
US

IV. Provider business mailing address

1600B CONGRESS ST
PORTLAND ME
04102-2124
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-5222
  • Fax: 207-761-4433
Mailing address:
  • Phone: 207-774-5222
  • Fax: 207-761-4433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateME

VIII. Authorized Official

Name: DR. MICHAEL C AKOM
Title or Position: PRESIDENT
Credential: MD
Phone: 207-774-5222