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Organization
MAINEHEALTH
Active
Organization
MAINEHEALTH
Active
Other names
MMC Family Practice Residency Program
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (SVP FINANCE/CFO)
(207) 662-3538
Entity
Organization
Contact information
Practice address
272 CONGRESS ST, PORTLAND, ME 04102
(207) 874-2466
(207) 774-4625
Mailing address
301C US ROUTE 1, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30216370
—
NH
Enumeration date
06/12/2007
Last updated
04/24/2020
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