MEDICARE: DR. FRED LINCOLN AVERY MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	012274	ME

General Provider Information

NPI Number	:	1750380838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRED LINCOLN AVERY MD

Provider Business Mailing Address
First Line	:	100 BRICKHILL AVENUE
Second Line	:	SUITE 303
City	:	SOUTH PORTLAND
State	:	ME
Zip	:	04106
Country	:	US
Telephone Number	:	207-773-0040
Fax Number	:	207-774-6501

Provider Business Practice Location Address
First Line	:	85 BRUCE HILL RD
Second Line	:
City	:	CUMBERLAND
State	:	ME
Zip	:	04021-3525
Country	:	US
Telephone Number	:	207-829-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/08/2011

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