Organization · Type 2 NPI

Mainehealth

Pediatric Surgery Physician · Portland, ME

NPI number 1780981803 Active

Practice location

887 Congress St, Suite 300
Portland, ME 04102

Call (207) 662-5555 Map

Fax (207) 662-5526

Mailing address

22 Bramhall St
Portland, ME 04102-3134

Specialties and licenses

Taxonomy	Code	License
Pediatric Surgery Physician Primary	2086S0120X	None listed
General Acute Care Hospital	282N00000X	37563 (ME)
Pediatric Nurse Practitioner	363LP0200X	None listed

Pediatric Surgery Physician: A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents.

107 other providers at this address

Other pediatric surgery physician providers in Portland

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NPI record

NPI: 1780981803
Entity type: Organization (Type 2)
Issued: Feb 25, 2011
Last updated: Dec 19, 2022
Status: Active
Subpart: Yes of Mainehealth

Other names

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Maine Medical Partners Pediatric Surgery · doing business as
Maine Medical Partners Pediatric Surgery · doing business as

Authorized official

Lugene Anthony Inzana
Associate CFO
(207) 662-3538

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1780981803

Mainehealth's National Provider Identifier is 1780981803, issued on Feb 25, 2011. The primary taxonomy on file is Pediatric Surgery Physician (2086S0120X), and the practice location is in Portland, ME. The record was last updated on Dec 19, 2022.