Organization
PHYSICAL REHABILITATION OF SOUTHERN MAINE PC
Active
Other names
Mary Macy MD
Organization subpart
No
Provider details
NPI number
Authorized official
MARY A MACY M.D. (OWNER)
(207) 854-1544
Entity
Organization
Contact information
Practice address
335 BRIGHTON AVE, PORTLAND, ME 04102-2362
(207) 497-2996
(207) 497-3467
Mailing address
PO BOX 810, WESTBROOK, ME 04098-0810
(207) 854-1544
(207) 854-1516
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
014605
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY #
ME
01
—
061235
ANTHEM
ME
01
—
1811907199
INDIVIDUAL NPI #
ME
01
—
ME1098
MEDICARE IND #
ME
Enumeration date
04/05/2007
Last updated
05/21/2020
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