Provider Demographics
NPI:1417087883
Name:MAINE NEONATOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MAINE NEONATOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-662-2553
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04104-0656
Mailing Address - Country:US
Mailing Address - Phone:800-482-1415
Mailing Address - Fax:941-907-1153
Practice Address - Street 1:22 BRAMHALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3175
Practice Address - Country:US
Practice Address - Phone:800-482-1415
Practice Address - Fax:941-907-1153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-12-23
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2008-12-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Single Specialty