Healthcare Provider Details

I. General information

NPI: 1548358302
Provider Name (Legal Business Name): CASCO BAY REHABILITATION, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE
PORTLAND ME
04102-2363
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 Number
License Number State

VIII. Authorized Official

Name: SYED KAZMI
Title or Position: MD
Credential: MD
Phone: 207-829-6009