| Gorham Primary Care Pc | |
|
130 Main St Gorham ME 04038-1319 | |
| (207) 839-5551 | |
| (207) 839-5573 |
| Full Name | Gorham Primary Care Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 130 Main St, Gorham, Maine |
| Authorized Official Name and Position | Andrew Stuart Nicholson (DIRECT/INDIRECT OWNER) |
| Authorized Official Contact | 2078395551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gorham Primary Care Pc 130 Main St Gorham ME 04038-1319 Ph: (207) 839-5551 | Gorham Primary Care Pc 130 Main St Gorham ME 04038-1319 Ph: (207) 839-5551 |
| NPI Number | 1851558399 |
|---|---|
| Provider Enumeration Date | 05/21/2008 |
| Last Update Date | 07/15/2008 |
| Medicare PECOS PAC ID | 4688747272 |
|---|---|
| Medicare Enrollment ID | O20080715000444 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851558399 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 015480 (Maine) | Primary |
| Provider Name | Andrew S Nicholson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295912665 PECOS PAC ID: 9133154164 Enrollment ID: I20050928001190 |
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