Provider Demographics
NPI:1639287139
Name:CAPITAL FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:CAPITAL FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERWIN
Authorized Official - Last Name:SZELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-623-4225
Mailing Address - Street 1:89 HOSPITAL ST
Mailing Address - Street 2:STE 2
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6656
Mailing Address - Country:US
Mailing Address - Phone:207-623-4225
Mailing Address - Fax:207-622-4699
Practice Address - Street 1:89 HOSPITAL ST
Practice Address - Street 2:STE 2
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6656
Practice Address - Country:US
Practice Address - Phone:207-623-4225
Practice Address - Fax:207-622-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B86397Medicare UPIN
MM0736Medicare ID - Type Unspecified