MEDICARE: MR. MARK ANDREW ROUILLARD

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1790101871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ANDREW ROUILLARD

Provider Business Mailing Address
First Line	:	62 OAK WOODS RD
Second Line	:
City	:	NORTH BERWICK
State	:	ME
Zip	:	03906-6121
Country	:	US
Telephone Number	:	207-432-1777
Fax Number	:

Provider Business Practice Location Address
First Line	:	62 OAK WOODS RD
Second Line	:
City	:	NORTH BERWICK
State	:	ME
Zip	:	03906-6121
Country	:	US
Telephone Number	:	207-432-1777
Fax Number	:

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

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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