Healthcare Provider Details

I. General information

NPI: 1285210054
Provider Name (Legal Business Name): WILLIAM THEODORE OLSEN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

IV. Provider business mailing address

11 CALDWELL RD
AUGUSTA ME
04330-5739
US

V. Phone/Fax

Practice location:
  • Phone: 207-213-2037
  • Fax:
Mailing address:
  • Phone: 207-213-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD30597
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: