Healthcare Provider Details

I. General information

NPI: 1578809794
Provider Name (Legal Business Name): GEORGE ALBARAN ELIAS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 07/21/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 KENNEDY MEMORIAL DR STE 204
WATERVILLE ME
04901-4541
US

IV. Provider business mailing address

180 KENNEDY MEMORIAL DR STE 204
WATERVILLE ME
04901-4541
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-7874
  • Fax:
Mailing address:
  • Phone: 207-861-7874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDO3105
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number22416
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20A15770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: