Provider Demographics
NPI:1669739389
Name:CASCO BAY MEDICAL PLLC
Entity type:Organization
Organization Name:CASCO BAY MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:SPIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-772-3221
Mailing Address - Street 1:371 FORE ST
Mailing Address - Street 2:201
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5112
Mailing Address - Country:US
Mailing Address - Phone:207-772-3221
Mailing Address - Fax:207-221-1152
Practice Address - Street 1:371 FORE ST
Practice Address - Street 2:201
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5112
Practice Address - Country:US
Practice Address - Phone:207-772-3221
Practice Address - Fax:207-221-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME015026261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health