Healthcare Provider Details

I. General information

NPI: 1548456866
Provider Name (Legal Business Name): HEAD AND NECK SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 KENNEDY MEMORIAL DR SUITE G
WATERVILLE ME
04901-4538
US

IV. Provider business mailing address

1250 FOREST AVE SUITE 301
PORTLAND ME
04103-1889
US

V. Phone/Fax

Practice location:
  • Phone: 207-872-1937
  • Fax: 207-872-1949
Mailing address:
  • Phone: 207-797-5753
  • Fax: 207-818-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELAINE H BUTLAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 207-797-5753