Provider Demographics
NPI:1891907978
Name:CENTRAL MAINE ENDOCRINOLOGY
Entity Type:Organization
Organization Name:CENTRAL MAINE ENDOCRINOLOGY
Other - Org Name:CENTRAL MAINE MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-795-7520
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-795-9520
Mailing Address - Fax:
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-795-9520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016051207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEH84267Medicare UPIN