Healthcare Provider Details

I. General information

NPI: 1669875639
Provider Name (Legal Business Name): ANTHEM HEALTH PLANS OF MAINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 GANNETT DR
SOUTH PORTLAND ME
04106-6909
US

IV. Provider business mailing address

2 GANNETT DR
SOUTH PORTLAND ME
04106-6909
US

V. Phone/Fax

Practice location:
  • Phone: 207-822-8223
  • Fax:
Mailing address:
  • Phone: 207-822-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DANIEL CORCORAN
Title or Position: PRESIDENT AND CHAIRMAN
Credential:
Phone: 207-822-8223