1699922468 NPI number — MICHAEL R LINCOURT MD PA

Table of content: (NPI 1699922468)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699922468 NPI number — MICHAEL R LINCOURT MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL R LINCOURT MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699922468
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 149
Provider Second Line Business Mailing Address:
866 MAIN STREET
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04073-0149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-324-6116
Provider Business Mailing Address Fax Number:
207-324-3968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
866 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04073-3530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-324-6116
Provider Business Practice Location Address Fax Number:
207-324-3968
Provider Enumeration Date:
08/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LINCOURT
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
207-324-6116

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  010941 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)