=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134288582
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAURICE C. HOTHEM, DO PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 AUBURN ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-6004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-797-4148
-----------------------------------------------------
Fax | 207-797-5730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 AUBURN ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-6004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-797-4148
-----------------------------------------------------
Fax | 207-797-5730
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND PROVIDER
-----------------------------------------------------
Name | MC HOTHEM
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 207-797-4148
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------