Healthcare Provider Details

I. General information

NPI: 1578256954
Provider Name (Legal Business Name): KELSEY PRICILLE PELLETIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CARTER ST
EAGLE LAKE ME
04739-3060
US

IV. Provider business mailing address

10 CARTER ST
EAGLE LAKE ME
04739-3060
US

V. Phone/Fax

Practice location:
  • Phone: 207-444-5973
  • Fax: 207-444-5520
Mailing address:
  • Phone: 207-444-5973
  • Fax: 207-444-5520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO4403
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: