Provider Demographics
NPI:1760628358
Name:MARITIME RADIOLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:MARITIME RADIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLAUCO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARESCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-265-4924
Mailing Address - Street 1:251 NAJOLES RD STE A
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2519
Mailing Address - Country:US
Mailing Address - Phone:443-274-2888
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:194 E MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1428
Practice Address - Country:US
Practice Address - Phone:207-834-3155
Practice Address - Fax:443-274-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-02
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1760628358Medicaid