Healthcare Provider Details

I. General information

NPI: 1861671273
Provider Name (Legal Business Name): GREGORY JANCAITIS MED, ATC, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SACO RD
STANDISH ME
04084-6240
US

IV. Provider business mailing address

700 SACO RD
STANDISH ME
04084-6240
US

V. Phone/Fax

Practice location:
  • Phone: 207-642-5325
  • Fax: 207-929-9147
Mailing address:
  • Phone: 207-642-9080
  • Fax: 207-929-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT300
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: