=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558381863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 BAXTER BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-775-1524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 BAXTER BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04101-1823
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-775-1524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | DEBRA J FERRANTE
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 207-775-1524
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YX0007X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------