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General NPI Number Information
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NPI Number | 1265536817
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Entity Type | Organization
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Legal Business Name | MAINEHEALTH
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Dates
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Enumeration Date | 09/12/2006
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 22 BRAMHALL ST
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City | PORTLAND
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State | ME
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Zip | 04102
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Country | US
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Telephone | 207-662-2179
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Fax | 207-662-6326
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Provider Business Mailing Address
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Address Line | 301 US ROUTE 1 BUILDING C
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7609
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Country | US
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Telephone | 207-396-8600
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Fax | 207-396-8632
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Authorized Official
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Title or Position | ASSOCIATE CFO
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Name | LUGENE ANTHONY INZANA
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Credential |
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Telephone | 207-662-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number |
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License Number State |
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