Provider Demographics
NPI:1649502303
Name:JOHN P GMEINER, PHD, PA
Entity type:Organization
Organization Name:JOHN P GMEINER, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GMEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-985-8538
Mailing Address - Street 1:15 TIDEVIEW TER
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7223
Mailing Address - Country:US
Mailing Address - Phone:207-985-6440
Mailing Address - Fax:
Practice Address - Street 1:62 PORTLAND RD
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6658
Practice Address - Country:US
Practice Address - Phone:207-985-8538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS564261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)