Healthcare Provider Details

I. General information

NPI: 1114202561
Provider Name (Legal Business Name): MAINE CARDIOLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2011
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 GANNETT DR
SOUTH PORTLAND ME
04106-6942
US

IV. Provider business mailing address

119 GANNETT DR
SOUTH PORTLAND ME
04106-6942
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-2642
  • Fax: 207-774-4293
Mailing address:
  • Phone: 207-774-2642
  • Fax: 207-774-4293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KARL C SZE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 207-774-2642