John Mamon, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD23752 Issued in ME

Practice address

6 Glen Cove Dr
Rockport, ME 04856-4272

Phone

(207) 662-4735

Fax

(207) 662-6388

NPI assigned

Dec 5, 2005

Last updated

Sep 22, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Radiology, Inc

  • Diagnostic Radiology Physician
  • Mishawaka, IN
  • NPI 1578557815
  NPD (past)

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1669456406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 GLEN COVE DR",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 GLEN COVE DR",
            "city": "ROCKPORT",
            "state": "ME",
            "postal_code": "048564272",
            "telephone_number": "207-662-4735",
            "fax_number": "207-662-6388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAMON",
        "first_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "ME",
            "license": "MD23752",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036075457",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669456406",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036075457",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mainehealth (MaineHealth Pen Bay Hospital Swing Bed)
• Mainehealth (MaineHealth Pen Bay Hospital)
• Mainehealth Care at Home (MaineHealth Home Health and Hospice)
• Alison R Maloof, ND
• Rohith R Malya, MD
• Joseph John Manavola, MD
• Alicia M Mancuso, DO
• Ira G. Mandel, M.D.
• Lisa B Manley, DPT
• Mark Manzi, PHARMACIST

• Diagnostic Radiology Physician in Rockport, ME
• Providers in Rockport, ME by specialty
• Diagnostic Radiology Physician in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2020; 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.