Organization
KENNEBEC VALLEY RADIOLOGY PROFESSIONAL ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAMELA S MANSIR (BUSINESS MANAGER)
(207) 622-4231
Entity
Organization
Contact information
Practice address
28 ARSENAL ST, AUGUSTA, ME 04330-5226
(207) 622-4231
(207) 623-1580
Mailing address
28 ARSENAL ST, AUGUSTA, ME 04330-5226
(207) 622-4231
(207) 623-1580
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0062588
AETNA
ME
01
—
0607
ANTHEM BC/BS OF MAINE
ME
01
—
101613
BC/BS OF MASS
ME
05
—
106860000
—
ME
Enumeration date
03/14/2006
Last updated
07/07/2008
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