Provider Demographics
NPI:1306017181
Name:ASTHMA & ALLERGY OF MAINE, LLC, PA
Entity Type:Organization
Organization Name:ASTHMA & ALLERGY OF MAINE, LLC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARESERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-626-4110
Mailing Address - Street 1:51 OCEAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2828
Mailing Address - Country:US
Mailing Address - Phone:207-626-4110
Mailing Address - Fax:207-626-4109
Practice Address - Street 1:51 OCEAN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2828
Practice Address - Country:US
Practice Address - Phone:207-626-4110
Practice Address - Fax:207-626-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty