Healthcare Provider Details

I. General information

NPI: 1871549451
Provider Name (Legal Business Name): STANLEY CHALEFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 11/26/2007

III. Provider practice location address

100 CAMPUS DR UNIT 107
SCARBOROUGH ME
04074-9692
US

IV. Provider business mailing address

190 RIVERSIDE ST SUITE 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-7565
  • Fax: 207-885-7577
Mailing address:
  • Phone: 207-661-2000
  • Fax: 207-661-2033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number017733
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: