Provider Demographics
NPI:1588826036
Name:CHANDRA SASSEVILLE DC PA
Entity type:Organization
Organization Name:CHANDRA SASSEVILLE DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-777-3333
Mailing Address - Street 1:416 SABATTUS ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5430
Mailing Address - Country:US
Mailing Address - Phone:207-777-3333
Mailing Address - Fax:207-786-8921
Practice Address - Street 1:416 SABATTUS ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5430
Practice Address - Country:US
Practice Address - Phone:207-777-3333
Practice Address - Fax:207-786-8921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEME421903261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022631OtherANTHEM
ME172742100OtherHARVARD PILGRIM
87726OtherUNITED HEALTHCARE
0474865OtherCIGNA
ME3435525OtherAETNA
ME0009707Medicare PIN