Provider Demographics
NPI:1053752584
Name:NEW ENGLAND TELEMEDICINE PA
Entity type:Organization
Organization Name:NEW ENGLAND TELEMEDICINE PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUSTIN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:ENNACHERIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-275-0464
Mailing Address - Street 1:98 ROUTE 236
Mailing Address - Street 2:SUITE #2
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-5527
Mailing Address - Country:US
Mailing Address - Phone:855-275-0464
Mailing Address - Fax:207-703-2780
Practice Address - Street 1:98 ROUTE 236
Practice Address - Street 2:SUITE 2
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-5527
Practice Address - Country:US
Practice Address - Phone:855-275-0464
Practice Address - Fax:207-703-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty