Healthcare Provider Details

I. General information

NPI: 1154702926
Provider Name (Legal Business Name): AARON PERREAULT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CHAPMAN ST
DAMARISCOTTA ME
04543-4614
US

IV. Provider business mailing address

68 CHAPMAN ST
DAMARISCOTTA ME
04543-4614
US

V. Phone/Fax

Practice location:
  • Phone: 207-563-6616
  • Fax:
Mailing address:
  • Phone: 603-455-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101260850
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number160257
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26093
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: