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General NPI Number Information
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NPI Number | 1033367982
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Entity Type | Organization
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Legal Business Name | INTERMED, PA
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Dates
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Enumeration Date | 09/04/2008
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 50 FODEN RD
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1718
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Country | US
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Telephone | 207-828-0361
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Fax | 207-874-1483
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Provider Business Mailing Address
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Address Line | 100 GANNETT DRIVE SUITE C
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-828-0361
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Fax | 207-874-1483
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROGER A. POITRAS
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Credential |
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Telephone | 207-347-2947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 20D0088755
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License Number State | ME
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