MEDICARE: RADIOLOGY SPECIALISTS OF MAINE, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology 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	:	1538163100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RADIOLOGY SPECIALISTS OF MAINE, PA

Provider Business Mailing Address
First Line	:	PO BOX 1849
Second Line	:
City	:	LEWISTON
State	:	ME
Zip	:	04241-1849
Country	:	US
Telephone Number	:	207-784-2554
Fax Number	:	207-777-5363

Provider Business Practice Location Address
First Line	:	329 MAINE ST
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-3310
Country	:	US
Telephone Number	:	207-373-2252
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT OF GROUP
Name	:	JOAN SUTCLIFFE
Credential	:	M.D.
Telephone Number	:	207-784-2554

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	11/12/2014

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