| Organization Name: | GORHAM CROSSING PRIMARY CARE |
| NPI Number: | 1013383777 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MICHAEL DUFFY (MEDICAL DIRECTOR) |
| Mailing Address: | 19 S Gorham Xing Gorham |
| State: | ME US |
| Postal Code: | 040382690 |
| Phone Number: | 2078399101 |
| Fax Number: | 2078399201 |
| NPI Enumeration Date: | 08/18/2015 |
| NPI Last Update Date: | 08/18/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | CNP151056 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |