MEDICARE: CAPE ELIZABETH FAMILY MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
2	363LF0000X	Family Nurse Practitioner
3	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154543130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAPE ELIZABETH FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	301 US ROUTE 1
Second Line	:	BUILDING C
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7609
Country	:	US
Telephone Number	:	207-396-8600
Fax Number	:	207-396-8632

Provider Business Practice Location Address
First Line	:	1226 SHORE RD
Second Line	:
City	:	CAPE ELIZABETH
State	:	ME
Zip	:	04107-2123
Country	:	US
Telephone Number	:	207-799-4050
Fax Number	:	207-799-4758

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CRAIG E JOHNSON
Credential	:	M.D.
Telephone Number	:	207-799-4050

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	12/29/2010

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