Healthcare Provider Details

I. General information

NPI: 1376533570
Provider Name (Legal Business Name): PORT CITY NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PORTLAND FARMS RD # 2
SCARBOROUGH ME
04074-8305
US

IV. Provider business mailing address

7 PORTLAND FARMS RD # 2
SCARBOROUGH ME
04074-8305
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-1400
  • Fax:
Mailing address:
  • Phone: 207-885-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1724
License Number StateME

VIII. Authorized Official

Name: EDWARD DRASBY
Title or Position: PRESIDENT
Credential: DO
Phone: 207-822-9894