Provider Demographics
NPI:1770392037
Name:MAINE COAST RHEUMATOLOGY PLLC
Entity type:Organization
Organization Name:MAINE COAST RHEUMATOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VRADII
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-578-6608
Mailing Address - Street 1:8 MASON
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-1514
Mailing Address - Country:US
Mailing Address - Phone:075-786-6082
Mailing Address - Fax:
Practice Address - Street 1:8 MASON STREET
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1514
Practice Address - Country:US
Practice Address - Phone:207-578-6608
Practice Address - Fax:207-503-7534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty