Healthcare Provider Details

I. General information

NPI: 1023402674
Provider Name (Legal Business Name): JESSICA FARACI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2015
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MAINE ST STE A200
BRUNSWICK ME
04011-3310
US

IV. Provider business mailing address

272 CONGRESS ST
PORTLAND ME
04101-3637
US

V. Phone/Fax

Practice location:
  • Phone: 207-373-4700
  • Fax: 207-729-0950
Mailing address:
  • Phone: 207-874-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042-0014254
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24440
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: