Provider Demographics
NPI:1134288582
Name:MAURICE C. HOTHEM, DO PA
Entity Type:Organization
Organization Name:MAURICE C. HOTHEM, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MC
Authorized Official - Middle Name:
Authorized Official - Last Name:HOTHEM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-797-4148
Mailing Address - Street 1:222 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6004
Mailing Address - Country:US
Mailing Address - Phone:207-797-4148
Mailing Address - Fax:207-797-5730
Practice Address - Street 1:222 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6004
Practice Address - Country:US
Practice Address - Phone:207-797-4148
Practice Address - Fax:207-797-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115730000Medicaid
MEM9150OtherCIGNA
ME010055318Medicare PIN
ME115730000Medicaid