Healthcare Provider Details

I. General information

NPI: 1003828419
Provider Name (Legal Business Name): JOSEPH CHARLES PELLETIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 MEDICAL CENTER DR STE 2200
BRUNSWICK ME
04011-2765
US

IV. Provider business mailing address

81 MEDICAL CENTER DR STE 2200
BRUNSWICK ME
04011-2765
US

V. Phone/Fax

Practice location:
  • Phone: 207-721-8333
  • Fax: 207-618-5670
Mailing address:
  • Phone: 207-721-8333
  • Fax: 207-618-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0420010598
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29779
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: