Provider Demographics
NPI:1679539167
Name:MAINEGENERAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:MAINEGENERAL HEALTH ASSOCIATES
Other - Org Name:MGHA ONCOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, MGHA
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-626-1063
Mailing Address - Street 1:150 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2615
Mailing Address - Country:US
Mailing Address - Phone:207-621-9337
Mailing Address - Fax:207-621-3609
Practice Address - Street 1:361 OLD BELGRADE RD
Practice Address - Street 2:ALFOND CANCER CENTER
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8058
Practice Address - Country:US
Practice Address - Phone:207-621-6100
Practice Address - Fax:207-621-6102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RH0003X, 363A00000X
ME207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7495Medicare PIN