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General NPI Number Information
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NPI Number | 1770392037
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Entity Type | Organization
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Legal Business Name | MAINE COAST RHEUMATOLOGY PLLC
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 8 MASON STREET
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City | BRUNSWICK
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State | ME
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Zip | 04011-1514
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Country | US
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Telephone | 207-578-6608
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Fax | 207-503-7534
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Provider Business Mailing Address
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Address Line | 8 MASON
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City | BRUNSWICK
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State | ME
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Zip | 04011-1514
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Country | US
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Telephone | 75-786-6082
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | DIANA VRADII
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Credential | MD
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Telephone | 207-578-6608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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