Healthcare Provider Details

I. General information

NPI: 1306801444
Provider Name (Legal Business Name): RICHARD J DECAROLIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 RAILROAD ST
BETHEL ME
04217
US

IV. Provider business mailing address

PO BOX 1367 32 RAILROAD ST
BETHEL ME
04217
US

V. Phone/Fax

Practice location:
  • Phone: 207-824-2193
  • Fax: 207-824-0012
Mailing address:
  • Phone: 207-824-2193
  • Fax: 207-824-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1431
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: