Healthcare Provider Details

I. General information

NPI: 1063566925
Provider Name (Legal Business Name): PAULA CLAIRE KIRBY-LONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 HIGH ST STE 300
LEWISTON ME
04240-7591
US

IV. Provider business mailing address

76 HIGH ST STE 300
LEWISTON ME
04240-7591
US

V. Phone/Fax

Practice location:
  • Phone: 207-795-5544
  • Fax: 207-795-5645
Mailing address:
  • Phone: 207-795-5544
  • Fax: 207-795-5645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0420010074
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number018039
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: