Healthcare Provider Details

I. General information

NPI: 1629430087
Provider Name (Legal Business Name): REHABILITATION ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 BRIGHTON AVE STE 201
PORTLAND ME
04102-2365
US

IV. Provider business mailing address

PO BOX 3250
WINCHESTER VA
22604-2450
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-4000
  • Fax:
Mailing address:
  • Phone: 540-504-0118
  • Fax: 540-678-9025

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: FRED FRIDMAN
Title or Position: PRESIDENT
Credential: DO
Phone: 207-939-6789