=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801084256
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAINEGENERAL HEALTH ASSOCIATES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2007
-----------------------------------------------------
Last Update Date | 10/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 325B KENNEDY MEMORIAL DR
-----------------------------------------------------
City | WATERVILLE
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04901-4517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-872-4451
-----------------------------------------------------
Fax | 207-873-1873
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 DRESDEN AVE
-----------------------------------------------------
City | GARDINER
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04345-2615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-621-9337
-----------------------------------------------------
Fax | 207-621-3609
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT-MAINEGENERAL HEALTH ASSOC
-----------------------------------------------------
Name | BARBARA A CROWLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 207-626-1063
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------