=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235567843
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINE MOBILE MRI ASSOC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2013
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 MEDICAL CENTER PKWY STE A1606
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330-8160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-626-1499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 986520
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02298-6520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-626-1499
-----------------------------------------------------
Fax | 207-777-1439
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | JOSEPH T LAVERDIERE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-626-1499
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------