Organization
MAINE MOLECULAR IMAGING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN G DRAZBA (SENIOR V.P. & CHIEF ACCOUNTING OFCR)
(949) 282-6000
Entity
Organization
Contact information
Practice address
100 CAMPUS DR, SCARBOROUGH, ME 04074-9692
(800) 734-4132
(800) 273-2377
Mailing address
PO BOX 414025, BOSTON, MA 02241-4025
(949) 282-6000
Taxonomy
Speciality
Code
Description
License number
State
293D00000X
Physiological Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041536
ANTHEM BLUE CROSS/BLUE SH
ME
01
—
626446
HARVARD PILGRIM HEALTH
ME
Enumeration date
05/05/2006
Last updated
12/26/2007
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