Provider Demographics
NPI:1407975907
Name:MAINE NEUROLOGY, PA
Entity Type:Organization
Organization Name:MAINE NEUROLOGY, PA
Other - Org Name:MAINE NEUROLOGY MRI
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-885-4357
Mailing Address - Street 1:49 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8926
Mailing Address - Country:US
Mailing Address - Phone:207-885-4424
Mailing Address - Fax:
Practice Address - Street 1:49 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-885-4424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1223780OtherAETNA INS CO
MEMM0928Medicare ID - Type Unspecified