Provider Demographics
NPI:1790148260
Name:MAVROMATES, SPIRO (MD)
Entity Type:Individual
Prefix:
First Name:SPIRO
Middle Name:
Last Name:MAVROMATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 POOLER PKWY
Mailing Address - Street 2:PMB 132
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-5102
Mailing Address - Country:US
Mailing Address - Phone:912-656-1071
Mailing Address - Fax:
Practice Address - Street 1:1 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:207-283-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD26326207R00000X
GA79517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine