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Organization
MAINEHEALTH
Active
Organization
MAINEHEALTH
Active
Other names
KENNETH AULT MD
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (CHIEF FINANCIAL OFFICER)
(207) 662-3538
Entity
Organization
Contact information
Practice address
81 RESEARCH DR, SCARBOROUGH, ME 04074
(207) 885-8130
(207) 885-8110
Mailing address
39 WALLACE AVE, SOUTH PORTLAND, ME 04106-6143
(207) 761-0650
(207) 761-8198
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
207RH0000X
Hematology (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119910015
—
ME
Enumeration date
09/07/2006
Last updated
05/11/2020
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