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General NPI Number Information
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NPI Number | 1972678373
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Entity Type | Organization
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Legal Business Name | CENTRAL MAINE GASTROENTEROLOGY ASSOCIATES
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 77 BATES ST 202
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City | LEWISTON
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State | ME
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Zip | 04240
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Country | US
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Telephone | 207-784-5784
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Fax | 207-784-1477
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Provider Business Mailing Address
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Address Line | 77 BATES ST 202
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City | LEWISTON
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State | ME
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Zip | 04240
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Country | US
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Telephone | 207-784-5784
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Fax | 207-784-1477
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Authorized Official
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Title or Position | INSURANCE CODER
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Name | MRS. CANDACE P BLAIS
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Credential | CPC
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Telephone | 207-784-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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