Healthcare Provider Details

I. General information

NPI: 1447211073
Provider Name (Legal Business Name): TERESA BREAULT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 HIGH ST
NORTH BERWICK ME
03906-6100
US

IV. Provider business mailing address

7 HIGH ST
NORTH BERWICK ME
03906-6100
US

V. Phone/Fax

Practice location:
  • Phone: 207-676-8559
  • Fax: 207-676-0982
Mailing address:
  • Phone: 207-676-8559
  • Fax: 207-676-0982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015101
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: