Provider Demographics
NPI:1215025028
Name:MEDICAL HOUSE CALLS OF SOUTHERN MAINE
Entity Type:Organization
Organization Name:MEDICAL HOUSE CALLS OF SOUTHERN MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-318-5348
Mailing Address - Street 1:211 MARGINAL WAY
Mailing Address - Street 2:SUITE 717
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2438
Mailing Address - Country:US
Mailing Address - Phone:207-318-5348
Mailing Address - Fax:866-275-1475
Practice Address - Street 1:211 MARGINAL WAY
Practice Address - Street 2:SUITE 717
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2438
Practice Address - Country:US
Practice Address - Phone:207-318-5348
Practice Address - Fax:866-275-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty