Healthcare Provider Details

I. General information

NPI: 1699771964
Provider Name (Legal Business Name): ALAN CHASTANET, PA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 FRANKLIN ST
RUMFORD ME
04276-2104
US

IV. Provider business mailing address

PO BOX 1849
LEWISTON ME
04241-1849
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-4581
  • Fax:
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-783-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number012805
License Number StateME

VIII. Authorized Official

Name: ALAN A CHASTANET
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-364-4581