Provider Demographics
NPI:1447520366
Name:MAINE INTEGRATIVE FAMILY CARE
Entity type:Organization
Organization Name:MAINE INTEGRATIVE FAMILY CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, DIRECT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:HAGOPIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-544-9800
Mailing Address - Street 1:144 THADEUS ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-544-9800
Mailing Address - Fax:207-544-9900
Practice Address - Street 1:144 THADEUS ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-544-9800
Practice Address - Fax:207-544-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2150207Q00000X
207Q00000X
ME2142208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty