Organization
WATERBORO VILLAGE PEDIATRICS LLC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEASHA DANIELLE MARESCOT MD (CO OWNER PARTNER)
(207) 247-6742
Entity
Organization
Contact information
Practice address
43 SOKOKIS TRAIL, EAST WATERBORO, ME 04030
(207) 247-6742
(207) 247-6114
Mailing address
PO BOX 1849, LEWISTON, ME 04241-1849
(207) 784-2554
(207) 777-5363
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
157150000
—
ME
05
—
30213870
—
NH
Enumeration date
01/19/2006
Last updated
05/07/2008
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