Healthcare Provider Details

I. General information

NPI: 1013036789
Provider Name (Legal Business Name): CAROLYN PLOURDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 MAIN ST SUITE 9
NORWAY ME
04268-5645
US

IV. Provider business mailing address

190 RIVERSIDE ST SUITE 6B
PORTLAND ME
04103-1073
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7605
  • Fax: 207-743-1579
Mailing address:
  • Phone: 207-661-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD16529
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: