Provider Demographics
NPI:1073676425
Name:OCEANSIDE MEDICAL,PA
Entity Type:Organization
Organization Name:OCEANSIDE MEDICAL,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-338-9968
Mailing Address - Street 1:116 NORTHPORT AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6095
Mailing Address - Country:US
Mailing Address - Phone:207-338-9968
Mailing Address - Fax:207-338-0332
Practice Address - Street 1:116 NORTHPORT AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6095
Practice Address - Country:US
Practice Address - Phone:207-338-9968
Practice Address - Fax:207-338-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013771173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133070000Medicaid
ME133070000Medicaid