Organization
THE JASON PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DIANA H HURD (PRACTICE MANAGER)
(207) 773-2947
Entity
Organization
Contact information
Practice address
65 WASHINGTON AVE, PORTLAND, ME 04101-2617
(207) 773-2947
(207) 773-3617
Mailing address
65 WASHINGTON AVE, PORTLAND, ME 04101-2617
(207) 773-2947
(207) 773-3617
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
012046
ME
Other
Enumeration date
10/31/2007
Last updated
10/31/2007
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