Healthcare Provider Details

I. General information

NPI: 1457458515
Provider Name (Legal Business Name): ROBERT M HAILE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2362
US

IV. Provider business mailing address

335 BRIGHTON AVE
PORTLAND ME
04102-2363
US

V. Phone/Fax

Practice location:
  • Phone: 207-829-6009
  • Fax: 207-829-6022
Mailing address:
  • Phone: 207-829-6009
  • Fax: 207-829-6022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number012282
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: