Mainehealth
Urology, Pediatric Urology in Portland, ME. Organization (NPI-2).
NPI number1457540486
StatusActive
Last updated in NPPESMay 11, 2020
Details
- NPI
- 1457540486
- Entity type
- Organization (NPI-2)
- Legal business name
- Mainehealth
- Organization subpart
- No
- Enumeration date
- Oct 16, 2007
- Certification date
- May 11, 2020
- Last updated
- May 11, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2088P0231X | Urology, Pediatric Urology | – | – | Yes |
Other names
- Mmc Pediatric Urology (Doing Business As)
Practice location
22 Bramhall StPortland, ME 04102
Phone 207-662-2179
Mailing address
301 Us Route 1Building C
Scarborough, ME 04074-7609
Phone 207-396-8600 · Fax 207-396-8632
Authorized official
Lugene Anthony Inzana
Associate Cfo
2076623538
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