Healthcare Provider Details

I. General information

NPI: 1295729531
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF PORTLAND, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SEWALL ST
PORTLAND ME
04102-2603
US

IV. Provider business mailing address

PO BOX 1260
PORTLAND ME
04104-1260
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-2100
  • Fax: 207-828-2190
Mailing address:
  • Phone: 207-828-2100
  • Fax: 207-828-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateME

VIII. Authorized Official

Name: MR. WILLIAM JOHN WIPFLER
Title or Position: OFFICER
Credential:
Phone: 207-828-2100