Provider Demographics
NPI:1407874274
Name:NEUROLOGY ASSOCIATES OF EASTERN MAINE, P.A.
Entity Type:Organization
Organization Name:NEUROLOGY ASSOCIATES OF EASTERN MAINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:LASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-947-0558
Mailing Address - Street 1:498 ESSEX ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3990
Mailing Address - Country:US
Mailing Address - Phone:207-947-0558
Mailing Address - Fax:207-947-0344
Practice Address - Street 1:498 ESSEX ST
Practice Address - Street 2:SUITE 105
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3990
Practice Address - Country:US
Practice Address - Phone:207-947-0558
Practice Address - Fax:207-947-0344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME073015Medicare ID - Type Unspecified