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General NPI Number Information
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NPI Number | 1669739389
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Entity Type | Organization
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Legal Business Name | CASCO BAY MEDICAL PLLC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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Provider Practice Location Address
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Address Line | 371 FORE ST 201
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City | PORTLAND
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State | ME
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Zip | 04101-5112
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Country | US
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Telephone | 207-772-3221
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Fax | 207-221-1152
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Provider Business Mailing Address
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Address Line | 371 FORE ST 201
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City | PORTLAND
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State | ME
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Zip | 04101-5112
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Country | US
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Telephone | 207-772-3221
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Fax | 207-221-1152
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JEREMY ASHLEY SPIEGEL
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Credential | M.D.
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Telephone | 207-772-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 015026
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License Number State | ME
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