Organization
MAINEHEALTH
Active
Other names
Geriatric Consults
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (SVP FINANCE/CFO)
(207) 662-3538
Entity
Organization
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102
(207) 662-6353
Mailing address
301 US ROUTE 1, BUILDING C, SCARBOROUGH, ME 04074-7609
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500205
—
ME
05
—
30216948
—
NH
Enumeration date
10/15/2007
Last updated
04/01/2025
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