MEDICARE: RICHARD E FORTIER JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	8000	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002189	OTHER	ME	STAR NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104853332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD E FORTIER JR.

Provider Business Mailing Address
First Line	:	60 PINELAND DR
Second Line	:
City	:	NEW GLOUCESTER
State	:	ME
Zip	:	04260-5124
Country	:	US
Telephone Number	:	207-688-8700
Fax Number	:	207-688-8701

Provider Business Practice Location Address
First Line	:	60 PINELAND DR
Second Line	:
City	:	NEW GLOUCESTER
State	:	ME
Zip	:	04260-5124
Country	:	US
Telephone Number	:	207-688-8700
Fax Number	:	207-688-8701

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	03/23/2010

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