Provider Demographics
NPI:1477830198
Name:MAINE VEIN CENTER ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MAINE VEIN CENTER ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DESMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:DONEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-774-5479
Mailing Address - Street 1:21 NORTHBROOK DR # B
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1379
Mailing Address - Country:US
Mailing Address - Phone:207-774-5479
Mailing Address - Fax:
Practice Address - Street 1:21 NORTHBROOK DR # B
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1379
Practice Address - Country:US
Practice Address - Phone:207-774-5479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-09
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0110982086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty