Healthcare Provider Details

I. General information

NPI: 1427496702
Provider Name (Legal Business Name): CHELSEA R L ROAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1206
  • Fax: 207-626-1648
Mailing address:
  • Phone: 207-626-1206
  • Fax: 207-626-1648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2659
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: