# MAINEHEALTH

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MMP Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639194509
- **Authorized official:** LUGENE ANTHONY INZANA (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (207) 662-3538

## Contact information

- **Practice address:** 272 CONGRESS ST, PORTLAND, ME 04101
- **Practice address phone:** (207) 874-2466
- **Practice address fax:** (207) 774-4625
- **Mailing address:** 300 SOUTHBOROUGH DR, SUITE 201, SOUTH PORTLAND, ME 04106-6914
- **Mailing address phone:** (207) 661-2000
- **Mailing address fax:** (207) 661-2033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | — | — |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 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

- **Enumeration date:** 07/13/2006
- **Last updated:** 12/19/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 102500000 | — | ME |
| 05 | — | 102500200 | — | ME |
| 05 | — | 102500202 | — | ME |
| 05 | — | 30216370 | — | NH |