Provider Demographics
NPI:1205836749
Name:MAINE CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MAINE CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-774-2642
Mailing Address - Street 1:119 GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6942
Mailing Address - Country:US
Mailing Address - Phone:207-774-2642
Mailing Address - Fax:207-774-4293
Practice Address - Street 1:119 GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6942
Practice Address - Country:US
Practice Address - Phone:207-774-2642
Practice Address - Fax:207-774-4293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM6678Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NHRE5022Medicare PIN
ME085456Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER