Healthcare Provider Details

I. General information

NPI: 1386731552
Provider Name (Legal Business Name): MASSABESIC REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 MAIN STREET
WATERBORO ME
04027
US

IV. Provider business mailing address

813 MAIN STREET MASSABESIC REGIONAL MEDICAL CENTER
WATERBORO ME
04027
US

V. Phone/Fax

Practice location:
  • Phone: 207-247-6131
  • Fax: 207-247-6675
Mailing address:
  • Phone: 207-247-6131
  • Fax: 207-247-6675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GAIL M WALLINGFORD
Title or Position: NURSE/BILLING/INSURANCE PROVIDER
Credential:
Phone: 207-247-6131