Provider Demographics
NPI:1558381863
Name:MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A
Entity Type:Organization
Organization Name:MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FERRANTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:207-775-1524
Mailing Address - Street 1:43 BAXTER BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1823
Mailing Address - Country:US
Mailing Address - Phone:207-775-1524
Mailing Address - Fax:
Practice Address - Street 1:43 BAXTER BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1823
Practice Address - Country:US
Practice Address - Phone:207-775-1524
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME002412OtherDR KLUGER INDIV ANTHEM #
ME002415OtherDR MAXWELL INDIV ANTHEM #
ME027846OtherDR MAKARETZ ANTHEM INDIV
ME040924OtherDR FRIBERG INDIV ANTHEM #
MEM2990OtherHEALTHSOURCE GROUP #
MEMM0108Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER
MEC66124Medicare UPIN
MEB58025Medicare UPIN
ME002412OtherDR KLUGER INDIV ANTHEM #
MED93074Medicare UPIN