=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720908254
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MD3 OF MAINE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2026
-----------------------------------------------------
Last Update Date | 07/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CONY RD STE C
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330-0506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-485-2666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CONY RD STE C
-----------------------------------------------------
City | AUGUSTA
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04330-0506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-485-2666
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ASSISTANT DIRECTOR
-----------------------------------------------------
Name | DR. JONNATHAN BUSKO
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-485-2666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207PE0004X
-----------------------------------------------------
Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------