Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1631 | ME |
N | 111NI0900X | Internist | 1631 | ME |
Y | 207RA0401X | Internist - Addiction Medicine | 1631 | ME |
NPI | 1649216086 |
---|---|
Provider Name | Dr. Paul Gabriel Gosselin |
First Address | Augusta, ME 04330 |
Second Address | Augusta, ME 04330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2006 |
Last Update Date | 26/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030622895 | CHAMPUS (01) | ME |
175350000 | (05) | ME |
MM7829 | (02) |