Healthcare Provider Details

I. General information

NPI: 1518189349
Provider Name (Legal Business Name): JASON A LACHANCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CAMPUS DR
SCARBOROUGH ME
04074-9692
US

IV. Provider business mailing address

301C US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-883-0069
  • Fax: 207-883-0999
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD12732
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD18183
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: