Provider Demographics
NPI:1790004414
Name:UNIVERSITY OF MAINE SYSTEM
Entity Type:Organization
Organization Name:UNIVERSITY OF MAINE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-778-7200
Mailing Address - Street 1:111 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6823
Mailing Address - Country:US
Mailing Address - Phone:207-778-7200
Mailing Address - Fax:207-778-8183
Practice Address - Street 1:111 SOUTH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6823
Practice Address - Country:US
Practice Address - Phone:207-778-7200
Practice Address - Fax:207-778-8183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-20
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME9841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty