Healthcare Provider Details

I. General information

NPI: 1124935432
Provider Name (Legal Business Name): ADAM MANGIAFICO EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 BROADWAY
SOUTH PORTLAND ME
04106-4407
US

IV. Provider business mailing address

684 BROADWAY
SOUTH PORTLAND ME
04106-4407
US

V. Phone/Fax

Practice location:
  • Phone: 207-799-3314
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number31029
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: