Healthcare Provider Details

I. General information

NPI: 1366460537
Provider Name (Legal Business Name): PATRICIA ALYCE NOBEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 ENFIELD RD
LINCOLN ME
04457
US

IV. Provider business mailing address

26 ENFIELD RD P.O. BOX 579
LINCOLN ME
04457
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3299
  • Fax: 207-794-3305
Mailing address:
  • Phone: 207-794-3299
  • Fax: 207-794-3305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number013440
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: