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General NPI Number Information
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NPI Number | 1083901078
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Entity Type | Individual
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Provider Name | ALICIA M MANCUSO DO
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 15 ANCHOR DR STE 201
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City | ROCKPORT
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State | ME
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Zip | 04856-3848
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Country | US
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Telephone | 207-301-5900
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Fax | 207-301-5358
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Provider Business Mailing Address
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Address Line | 16 CONCOURSE W
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City | WATERVILLE
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State | ME
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Zip | 04901-6007
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Country | US
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Telephone | 207-861-1036
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Fax | 207-861-1039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO2440
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License Number State | ME
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