Maine Functional Medicine

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MAINE FUNCTIONAL MEDICINE

Practice address

33 Penn PLZ Ste a
Bangor, ME 04401-3619

Phone

(207) 941-0080

Fax

(207) 941-0093

NPI assigned

Jan 29, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Drake

Title

Office Manager

Phone

(207) 941-0080

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548720000000",
    "number": "1427512904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 PENN PLZ STE A",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013619",
            "telephone_number": "207-941-0080",
            "fax_number": "207-941-0093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 PENN PLZ STE A",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044013619",
            "telephone_number": "207-941-0080",
            "fax_number": "207-941-0093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINE FUNCTIONAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-29",
        "last_updated": "2019-01-29",
        "status": "A",
        "authorized_official_last_name": "DRAKE",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "207-941-0080"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1053336206",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Maietta, LCSW
• Brenda Mailman, RN
• Maine Coast Mobile Med, LLC
• Maine Coast Mobile Med. LLC
• Maine Family Dental Practice PA
• Maine Molecular Imaging LLC
• Maine Street Medicine Works, PLLC
• Maine Urology Associates P.a.
• Maine Veterans' Home
• Maine Veterans' Homes

• Family Medicine Physician in Bangor, ME
• Providers in Bangor, ME by specialty
• Family Medicine Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.