Organization Name: | MAINE OSTEOPATHIC MEDICINE, LLC |
NPI Number: | 1659715738 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHANIE W COLLINS (PHYSICIAN/OWNER) |
Mailing Address: | 146 Ocean St Suite 2 South Portland |
State: | ME US |
Postal Code: | 041063664 |
Phone Number: | 2077474455 |
Fax Number: | 8889075762 |
NPI Enumeration Date: | 04/19/2013 |
NPI Last Update Date: | 04/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 1663 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |