Healthcare Provider Details

I. General information

NPI: 1871574715
Provider Name (Legal Business Name): CHARLES E FOLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MAIN ST
LEWISTON ME
04240-7054
US

IV. Provider business mailing address

287 MAIN ST
LEWISTON ME
04240-7054
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-6543
  • Fax: 207-795-0488
Mailing address:
  • Phone: 207-795-6543
  • Fax: 207-795-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberTN38369
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberTN 38369
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberTN 38369
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number018741
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: