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General NPI Number Information
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NPI Number | 1548456866
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Entity Type | Organization
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Legal Business Name | HEAD AND NECK SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 09/30/2009
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Provider Practice Location Address
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Address Line | 244 KENNEDY MEMORIAL DR SUITE G
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City | WATERVILLE
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State | ME
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Zip | 04901-4538
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Country | US
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Telephone | 207-872-1937
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Fax | 207-872-1949
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Provider Business Mailing Address
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Address Line | 1250 FOREST AVE SUITE 301
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City | PORTLAND
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State | ME
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Zip | 04103-1889
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Country | US
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Telephone | 207-797-5753
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Fax | 207-818-1715
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ELAINE H BUTLAND
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Credential |
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Telephone | 207-797-5753
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number |
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License Number State |
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