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General NPI Number Information
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NPI Number | 1396737656
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Entity Type | Organization
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Legal Business Name | CASCO BAY SURGERY, PA
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Dates
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Enumeration Date | 08/22/2005
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 10 ANDOVER RD
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City | PORTLAND
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State | ME
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Zip | 04102-1954
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Country | US
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Telephone | 207-761-6642
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Fax | 207-773-2603
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Provider Business Mailing Address
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Address Line | 10 ANDOVER RD
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City | PORTLAND
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State | ME
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Zip | 04102-1954
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Country | US
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Telephone | 207-761-6642
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Fax | 207-773-2603
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. CATHEL AH MACLEOD
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Credential | MD
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Telephone | 207-761-6642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 014327
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 013447
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 016320
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License Number State | ME
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Taxonomy #4
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 012909
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License Number State | ME
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Taxonomy #5
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 014665
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License Number State | ME
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Taxonomy #6
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 015187
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License Number State | ME
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Taxonomy #7
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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 | ME
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