Healthcare Provider Details

I. General information

NPI: 1306017181
Provider Name (Legal Business Name): ASTHMA & ALLERGY OF MAINE, LLC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 OCEAN ST
SOUTH PORTLAND ME
04106-2828
US

IV. Provider business mailing address

51 OCEAN ST
SOUTH PORTLAND ME
04106-2828
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-4110
  • Fax: 207-626-4109
Mailing address:
  • Phone: 207-626-4110
  • Fax: 207-626-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MATTHEW J ARESERY
Title or Position: OWNER
Credential: MD
Phone: 207-626-4110