| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 9 Fahey St, Belfast, Maine |
| Authorized Official Name and Position | Thomas Roland Maycock (OWNER) |
| Authorized Official Contact | 2073381120 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9 Fahey St Belfast ME 04915-6028 Ph: (207) 338-1120 | 9 Fahey St Belfast ME 04915-6028 Ph: (207) 338-1120 |
| NPI Number | 1578777819 |
|---|---|
| Provider Enumeration Date | 05/09/2007 |
| Last Update Date | 09/15/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578777819 | NPI | - | NPPES |
| 080086258 | Other | ME | RR MEDICARE |
| 314800099 | Medicaid | ME | |
| 118460000 | Medicaid | ME | |
| 012002 | Other | ME | ANTHEM BC BS |
| E000363 | Other | ME | CHAMPUS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 008970 (Maine) | Primary |
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