1558381863 NPI number — MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A

Table of content: DR. BRIAN JOHN COURTRIGHT O.D. (NPI 1861471914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558381863 NPI number — MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXWELL, KLUGER AND MAKARETZ ENT ASSOC M.D.P.A
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:
1558381863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 BAXTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04101-1823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-775-1524
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 BAXTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04101-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-775-1524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FERRANTE
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
207-775-1524

Provider Taxonomy Codes

  • Taxonomy code: 207YX0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 002412 . This is a "DR KLUGER INDIV ANTHEM #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 002415 . This is a "DR MAXWELL INDIV ANTHEM #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 027846 . This is a "DR MAKARETZ ANTHEM INDIV" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 040924 . This is a "DR FRIBERG INDIV ANTHEM #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M2990 . This is a "HEALTHSOURCE GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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