Provider Demographics
NPI:1346316791
Name:MIDCOAST PEDIATRICS
Entity Type:Organization
Organization Name:MIDCOAST PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:ENRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-721-8333
Mailing Address - Street 1:121 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2653
Mailing Address - Country:US
Mailing Address - Phone:207-721-8333
Mailing Address - Fax:207-798-4618
Practice Address - Street 1:121 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 2600
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2653
Practice Address - Country:US
Practice Address - Phone:207-721-8333
Practice Address - Fax:207-798-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0019MOtherANTHEM