Healthcare Provider Details

I. General information

NPI: 1942453683
Provider Name (Legal Business Name): MAINEGENERAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 RAILROAD SQ KENNEBEC FAMILY PRACTICE
WATERVILLE ME
04901-6139
US

IV. Provider business mailing address

13 RAILROAD SQ KENNEBEC FAMILY PRACTICE
WATERVILLE ME
04901-6139
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-6869
  • Fax: 207-872-7910
Mailing address:
  • Phone: 207-872-6869
  • Fax: 207-872-7910

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: BARBARA A CROWLEY
Title or Position: PRESIDENT, MGHA
Credential: MD
Phone: 207-626-1097