Provider Demographics
NPI:1376533570
Name:PORT CITY NEUROLOGY
Entity Type:Organization
Organization Name:PORT CITY NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:DRASBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-822-9894
Mailing Address - Street 1:7 PORTLAND FARMS RD # 2
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8305
Mailing Address - Country:US
Mailing Address - Phone:207-885-1400
Mailing Address - Fax:
Practice Address - Street 1:7 PORTLAND FARMS RD # 2
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8305
Practice Address - Country:US
Practice Address - Phone:207-885-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME17242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1506Medicare PIN
MEDD5733Medicare PIN