1760628358 NPI number — MARITIME RADIOLOGY ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760628358 NPI number — MARITIME RADIOLOGY ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARITIME RADIOLOGY ASSOCIATES, P.C.
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:
1760628358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 NAJOLES RD STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21108-2519
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-274-2888
Provider Business Mailing Address Fax Number:
443-274-2391

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 UNION ST
Provider Second Line Business Practice Location Address:
MAINE COAST MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04605-1586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-664-5361
Provider Business Practice Location Address Fax Number:
443-274-2391
Provider Enumeration Date:
01/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MARESCA
Authorized Official First Name:
GLAUCO
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
315-265-4924

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1760628358 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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