Basic Information
| Provider Information | |||||||||
| NPI: | 1710408620 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAINE OSTEOPATHIC HEALTH LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 ELM ST | ||||||||
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| City: | GORHAM | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040381506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8609666372 | ||||||||
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| Address1: | 8 ELM ST | ||||||||
| Address2: | |||||||||
| City: | GORHAM | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040381506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077258079 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | POSCH | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8609666372 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM |
No ID Information.