Healthcare Provider Details

I. General information

NPI: 1902130743
Provider Name (Legal Business Name): CITY OF PORTLAND MAINE, HHS PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 CONGRESS ST ROOM 307
PORTLAND ME
04101-3566
US

IV. Provider business mailing address

389 CONGRESS ST ROOM 307
PORTLAND ME
04101-3566
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-8784
  • Fax: 297-874-8913
Mailing address:
  • Phone: 207-874-8784
  • Fax: 297-874-8913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH E, GRAY JR.
Title or Position: CITY MANAGER
Credential:
Phone: 207-874-8689