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General NPI Number Information
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NPI Number | 1518447325
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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 | 08/21/2018
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Last Update Date | 05/11/2020
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Provider Practice Location Address
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Address Line | 12 UNION ST
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City | ROCKLAND
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State | ME
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Zip | 04841-2739
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Country | US
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Telephone | 207-701-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 78 ATLANTIC PL
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-2316
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Country | US
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Telephone |
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Fax |
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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 | 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 #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 680905
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License Number State | ME
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