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General NPI Number Information
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NPI Number | 1316973969
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Entity Type | Individual
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Provider Name | EDWARD TUMAVICUS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 272 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04101-3637
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Country | US
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Telephone | 207-874-2466
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Fax |
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Provider Business Mailing Address
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Address Line | 301C US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9701
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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 |
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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 | 016829
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License Number State | ME
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