Provider Demographics
NPI:1699771964
Name:ALAN CHASTANET, PA, LLC
Entity type:Organization
Organization Name:ALAN CHASTANET, PA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHASTANET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-364-4581
Mailing Address - Street 1:PO BOX 1849
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04241-1849
Mailing Address - Country:US
Mailing Address - Phone:207-784-2554
Mailing Address - Fax:207-783-4079
Practice Address - Street 1:420 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2104
Practice Address - Country:US
Practice Address - Phone:207-364-4581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0128052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MECB3734OtherRR MEDICARE GROUP #
ME=========OtherTRICARE GROUP #
MECB3734OtherRR MEDICARE GROUP #
ME=========OtherBC/BS GROUP #
MEMM2852Medicare ID - Type UnspecifiedGROUP #