Healthcare Provider Details

I. General information

NPI: 1164757738
Provider Name (Legal Business Name): PAULINE KAREN MILLS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULINE CENTER

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BATH RD
BRUNSWICK ME
04011-2606
US

IV. Provider business mailing address

114 BATH RD
BRUNSWICK ME
04011-2606
US

V. Phone/Fax

Practice location:
  • Phone: 207-798-4400
  • Fax: 207-798-4452
Mailing address:
  • Phone: 207-798-4400
  • Fax: 207-798-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number042-0011870
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20929
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: