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Organization
MAINEHEALTH
Active
Organization
MAINEHEALTH
Active
Other names
MMP Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (CHIEF FINANCIAL OFFICER)
(207) 662-3538
Entity
Organization
Contact information
Practice address
272 CONGRESS ST, PORTLAND, ME 04101
(207) 874-2466
(207) 774-4625
Mailing address
300 SOUTHBOROUGH DR, SUITE 201, SOUTH PORTLAND, ME 04106-6914
(207) 661-2000
(207) 661-2033
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207QS0010X
Sports Medicine (Family Medicine) Physician
—
—
2084P0800X
Psychiatry Physician
—
—
363A00000X
Physician Assistant
—
—
363LW0102X
Women's Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500000
—
ME
05
—
102500200
—
ME
05
—
102500202
—
ME
05
—
30216370
—
NH
Enumeration date
07/13/2006
Last updated
12/19/2022
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