Organization
MAINEHEALTH
Active
Other names
MAINE TRANSPLANT PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
LUGENE ANTHONY INZANA (SVP FINANCE/CFO)
(207) 662-3538
Entity
Organization
Contact information
Practice address
19 WEST ST, PORTLAND, ME 04102
(207) 662-7180
(207) 662-7190
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
207R00000X
Internal Medicine Physician
—
—
207RN0300X
Nephrology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102500201
—
ME
05
—
30212545
—
NH
Enumeration date
09/12/2006
Last updated
12/19/2022
Update your record
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