Provider Demographics
NPI:1366506818
Name:COASTAL MAINE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:COASTAL MAINE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SCHENK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-230-8220
Mailing Address - Street 1:247 COMMERCIAL ST STE D
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-5964
Mailing Address - Country:US
Mailing Address - Phone:207-230-8220
Mailing Address - Fax:207-230-8346
Practice Address - Street 1:247 COMMERCIAL ST STE D
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5964
Practice Address - Country:US
Practice Address - Phone:207-230-8220
Practice Address - Fax:207-230-8346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1871207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEFIRST HEALTHOther5641527
ME061334OtherANTHEM
MEHARVARD PILGRIMOtherAA35830
MEAETNAOther3825048
ME431872600Medicaid
MEFIRST HEALTHOther5641527
MEHARVARD PILGRIMOtherAA35830
MEME1438Medicare PIN