Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | MD16529 | ME |
NPI | 1013036789 |
---|---|
Provider Name | Carolyn Plourde |
First Address | Portland, ME 04103-1073 |
Second Address | Norway, ME 04268-5645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 12/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30204424 | (05) | NH |
412990099 | (05) | ME |
G24915 | (02) | ME |