Healthcare Provider Details

I. General information

NPI: 1962962324
Provider Name (Legal Business Name): JUSTINE MARIE ACHILLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 MAIN ST
GORHAM ME
04038-2623
US

IV. Provider business mailing address

PO BOX 9746
PORTLAND ME
04104-5040
US

V. Phone/Fax

Practice location:
  • Phone: 207-839-2559
  • Fax:
Mailing address:
  • Phone: 207-828-2449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD26128
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: