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General NPI Number Information
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NPI Number | 1225911647
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Entity Type | Organization
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Legal Business Name | MMC ACO
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Dates
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Enumeration Date | 07/31/2025
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 335 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-2363
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Country | US
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Telephone | 207-518-8869
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Fax | 207-888-3733
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Provider Business Mailing Address
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Address Line | 91 AUBURN ST STE J1096
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City | PORTLAND
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State | ME
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Zip | 04103-6008
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Country | US
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Telephone | 207-518-8869
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Fax | 207-888-3733
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Authorized Official
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Title or Position | OWNER
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Name | FRED FRIDMAN
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Credential |
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Telephone | 207-939-6789
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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 |
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License Number State |
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