Provider Demographics
NPI:1356678387
Name:STATE OF MAINE
Entity Type:Organization
Organization Name:STATE OF MAINE
Other - Org Name:MAINE CENTER FOR DISEASE CONTROL/DIVISION OF INFECTIOUS DESEASE/MAINE
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIANCHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-287-3746
Mailing Address - Street 1:286 WATER STREET
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0011
Mailing Address - Country:US
Mailing Address - Phone:207-287-3746
Mailing Address - Fax:207-287-8127
Practice Address - Street 1:286 WATER STREET
Practice Address - Street 2:9TH FLOOR
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0011
Practice Address - Country:US
Practice Address - Phone:207-287-3746
Practice Address - Fax:207-287-8127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESTMM6853Medicare PIN