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General NPI Number Information
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NPI Number | 1356420400
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Entity Type | Organization
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Legal Business Name | MAINE CENTER FOR LIPIDS & CARDIOVASCULAR HEALTH LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 96 CAMPUS DR SUITE 2A
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7133
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Country | US
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Telephone | 207-885-8777
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Fax | 207-885-8770
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Provider Business Mailing Address
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Address Line | 96 CAMPUS DR SUITE 2A
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City | SCARBOROUGH
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State | ME
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Zip | 04074-7133
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Country | US
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Telephone | 207-885-8777
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Fax | 207-885-8770
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEONARD MARK KEILSON
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Credential | MD
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Telephone | 207-885-8777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01007
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License Number State | ME
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