Provider Demographics
NPI:1760767255
Name:MAINE CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:MAINE CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-774-2642
Mailing Address - Street 1:119 GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6942
Mailing Address - Country:US
Mailing Address - Phone:207-774-2642
Mailing Address - Fax:207-774-4293
Practice Address - Street 1:198 MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7640
Practice Address - Country:US
Practice Address - Phone:207-777-5300
Practice Address - Fax:207-774-4293
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE CARDIOLOGY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107650003Medicaid
ME085456Medicare PIN