Basic Information
| Provider Information | |||||||||
| NPI: | 1538176789 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEELE | ||||||||
| FirstName: | ERIK | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9746 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041045040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077913888 | ||||||||
| FaxNumber: | 2078287850 | ||||||||
| Practice Location | |||||||||
| Address1: | 153 US ROUTE 1 | ||||||||
| Address2: | |||||||||
| City: | SCARBOROUGH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040749052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077998596 | ||||||||
| FaxNumber: | 2077991730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 09/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 09/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 1269 | ME | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 1269 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | MM229401 | 01 | ME | MED B - BHMH 200051 | OTHER | 240640099 | 05 | ME | MEDICAID |