Provider Demographics
NPI:1639343429
Name:MAINE BONE & JOINT SPECIALISTS LLC
Entity Type:Organization
Organization Name:MAINE BONE & JOINT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-873-0200
Mailing Address - Street 1:107 FIRST PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963
Mailing Address - Country:US
Mailing Address - Phone:207-873-8100
Mailing Address - Fax:207-873-8101
Practice Address - Street 1:107 FIRST PARK DRIVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963
Practice Address - Country:US
Practice Address - Phone:207-873-8100
Practice Address - Fax:207-873-8101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432998300Medicaid
ME0006658Medicare PIN