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General NPI Number Information
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NPI Number | 1336538198
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Entity Type | Organization
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Legal Business Name | INTERMED, PA
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Dates
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Enumeration Date | 01/16/2015
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 84 MARGINAL WAY
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City | PORTLAND
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State | ME
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Zip | 04101-2443
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Country | US
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Telephone | 207-774-5816
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Fax | 207-523-8597
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Provider Business Mailing Address
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Address Line | 100 GANNETT DR SUITE C
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5900
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Country | US
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Telephone | 207-828-0361
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Fax | 207-874-1483
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROGER A. POITRAS
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Credential |
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Telephone | 207-347-2853
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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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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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