Healthcare Provider Details

I. General information

NPI: 1669734000
Provider Name (Legal Business Name): SARA CARRIE TAROLLI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MAIN ST
LEWISTON ME
04240-7027
US

IV. Provider business mailing address

300 MAIN ST
LEWISTON ME
04240-7027
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-0111
  • Fax: 207-795-2766
Mailing address:
  • Phone: 207-795-0111
  • Fax: 207-795-2766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD21139
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: