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Organization
FORE RIVER FAMILY MEDICINE, PA
Active
Organization
FORE RIVER FAMILY MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CATHERINE CRUTE (PRESIDENT/ OWNER)
(207) 772-8823
Entity
Organization
Contact information
Practice address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 772-8823
(207) 772-1856
Mailing address
51 SEWALL ST, PORTLAND, ME 04102-2643
(207) 772-8823
(207) 772-1856
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
012111
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
099071
ANTHEM
ME
01
—
2449295
AETNA
ME
01
—
8892325
CIGNA
ME
01
—
B86348
HARVARD PILGRIM
ME
Enumeration date
07/25/2007
Last updated
04/20/2008
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