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General NPI Number Information
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NPI Number | 1548730567
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Entity Type | Organization
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Legal Business Name | PEDS COVERAGE PC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/10/2018
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Provider Practice Location Address
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Address Line | 1577 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-2169
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Country | US
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Telephone | 207-662-1442
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1778
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City | LEWISTON
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State | ME
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Zip | 04241-1778
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Country | US
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Telephone | 207-375-3024
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Fax | 207-375-3026
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN BLUMENTHAL
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Credential | MD
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Telephone | 207-553-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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