Healthcare Provider Details

I. General information

NPI: 1710943592
Provider Name (Legal Business Name): MAINEGENERAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 NORTH ST
WATERVILLE ME
04901-4974
US

IV. Provider business mailing address

150 DRESDEN AVE
GARDINER ME
04345-2615
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1715
  • Fax: 207-872-1725
Mailing address:
  • Phone: 207-621-9337
  • Fax: 207-621-3609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A CROWLEY
Title or Position: PRESIDENT, MGHA
Credential: MD
Phone: 207-626-1063