Provider Demographics
NPI:1679642979
Name:GEORGITIS, JAMES W (MD, FACS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:GEORGITIS
Suffix:
Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:9 HEALTHCARE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9449
Mailing Address - Country:US
Mailing Address - Phone:207-282-9080
Mailing Address - Fax:207-282-9180
Practice Address - Street 1:3 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9422
Practice Address - Country:US
Practice Address - Phone:207-284-4597
Practice Address - Fax:207-282-9213
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2009-10-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME009793208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME262810099Medicaid
NH30207575Medicaid
ME01513901Medicare PIN
MEB86534Medicare UPIN
ME262810099Medicaid