Basic Information
| Provider Information | |||||||||
| NPI: | 1538125034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINEGENERAL HEALTH ASSOCIATES | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GERIATRICS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 DRESDEN AVE | ||||||||
| Address2: | |||||||||
| City: | GARDINER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043452615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076219337 | ||||||||
| FaxNumber: | 2076213609 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 GLENDRIDGE DR | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076262600 | ||||||||
| FaxNumber: | 2076210277 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2006 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CROWLEY | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN NETWORK COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 2076261063 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207QG0300X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.