Provider Demographics
NPI:1598780447
Name:MAINE MEDICAL PARTNERS
Entity Type:Organization
Organization Name:MAINE MEDICAL PARTNERS
Other - Org Name:MAINE MEDICAL PARTNERS INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KASABIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-661-2000
Mailing Address - Street 1:300 SOUTBOROUGH DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:207-661-2033
Practice Address - Street 1:155 SPURWINK AVE
Practice Address - Street 2:
Practice Address - City:CAPE ELIZABETH
Practice Address - State:ME
Practice Address - Zip Code:04107-9604
Practice Address - Country:US
Practice Address - Phone:207-767-2174
Practice Address - Fax:207-767-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119910009Medicaid
ME119910029Medicaid
NH30216636Medicaid
ME119910007Medicaid
ME119910006Medicaid
NH30217105Medicaid
ME119910008Medicaid
ME0907150003Medicare NSC
MECB8454Medicare PIN
MEMM6083Medicare PIN
ME119910009Medicaid
ME119910008Medicaid