Healthcare Provider Details

I. General information

NPI: 1154259018
Provider Name (Legal Business Name): MADELYN ROEHL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 NEW PORTLAND RD
GORHAM ME
04038-1542
US

IV. Provider business mailing address

1 GRIFFIN RD APT 1
SCARBOROUGH ME
04074-1701
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-5757
  • Fax:
Mailing address:
  • Phone: 320-583-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT7248
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: