Healthcare Provider Details

I. General information

NPI: 1518286798
Provider Name (Legal Business Name): REID C ANDRESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 BRAMHALL ST
PORTLAND ME
04102
US

IV. Provider business mailing address

301C US ROUTE ONE
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-4618
  • Fax: 207-662-6254
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD19784
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: