Healthcare Provider Details

I. General information

NPI: 1497688766
Provider Name (Legal Business Name): SEBAGO MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 TANDBERG TRL
WINDHAM ME
04062-5206
US

IV. Provider business mailing address

110 TANDBERG TRL
WINDHAM ME
04062-5206
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-8359
  • Fax: 207-544-5150
Mailing address:
  • Phone: 207-893-8359
  • Fax: 207-544-5150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MIRANDA CHIN
Title or Position: ADMINISTRATIVE
Credential:
Phone: 207-595-9290