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General NPI Number Information
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NPI Number | 1609694207
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Entity Type | Organization
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Legal Business Name | CONVENIENTMD LLC
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 211 MARGINAL WAY
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City | PORTLAND
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State | ME
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Zip | 04101-2467
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Country | US
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Telephone | 207-544-9355
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Fax | 207-544-7756
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Provider Business Mailing Address
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Address Line | 360 US HIGHWAY 1 BYP UNIT 102
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City | PORTSMOUTH
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State | NH
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Zip | 03801-7105
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Country | US
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Telephone | 603-410-6700
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Fax |
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Authorized Official
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Title or Position | CEO, MANAGING EMPLOYEE
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Name | GARETH DICKENS
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Credential |
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Telephone | 603-501-0863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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