Healthcare Provider Details

I. General information

NPI: 1558381863
Provider Name (Legal Business Name): MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

IV. Provider business mailing address

43 BAXTER BLVD
PORTLAND ME
04101-1823
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-1524
  • Fax:
Mailing address:
  • Phone: 207-775-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBRA J FERRANTE
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 207-775-1524