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General NPI Number Information
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NPI Number | 1942388418
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Entity Type | Organization
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Legal Business Name | INTERMED, PA
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 84 MARGINAL WAY SUITE 1000
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City | PORTLAND
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State | ME
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Zip | 04101-2443
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Country | US
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Telephone | 207-347-2898
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Fax | 207-553-1415
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Provider Business Mailing Address
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Address Line | 300 SOUTHBOROUGH DR STE 120
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-6978
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Country | US
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Telephone | 207-347-2947
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Fax | 207-874-1483
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | ROGER POITRAS
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Credential |
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Telephone | 207-347-2853
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 38444
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License Number State | ME
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