Provider Demographics
NPI:1104998905
Name:PLACE, JAMES N (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:PLACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-482-7800
Mailing Address - Fax:
Practice Address - Street 1:93 CAMPUS AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6030
Practice Address - Country:US
Practice Address - Phone:207-777-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD127552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME300061960Medicare ID - Type UnspecifiedRAILROAD
ME252260099Medicaid
NH01Y000262NH01OtherANTHEM
ME026376OtherANTHEM
MEMM3788Medicare ID - Type Unspecified
NH30008330Medicaid
MEM3422OtherCIGNA
ME1041926OtherAETNA USHC
MEE90393Medicare UPIN
ME5621479OtherAETNA
MEE90393OtherHPHC
NHRE7123Medicare ID - Type Unspecified