Healthcare Provider Details

I. General information

NPI: 1811240914
Provider Name (Legal Business Name): HAMZA A HAADOOW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 ANDERSON ST STE 1A
PORTLAND ME
04101-2596
US

IV. Provider business mailing address

1 COAST LN
PORTLAND ME
04103-2844
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-1400
  • Fax: 800-531-7680
Mailing address:
  • Phone: 207-228-0697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: