Provider Demographics
NPI:1568615649
Name:PROGRESSIVE MEDICAL CARE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEHSEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAQVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-899-3680
Mailing Address - Street 1:53 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1408
Mailing Address - Country:US
Mailing Address - Phone:207-899-3680
Mailing Address - Fax:207-899-3680
Practice Address - Street 1:335 BRIGHTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2363
Practice Address - Country:US
Practice Address - Phone:207-899-3680
Practice Address - Fax:207-899-3680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME017608207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0009684Medicare PIN