Healthcare Provider Details

I. General information

NPI: 1649249079
Provider Name (Legal Business Name): GARY M CHALOULT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 08/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 S GAGE RD
OAKLAND ME
04963
US

IV. Provider business mailing address

35 S GAGE RD
OAKLAND ME
04963-4526
US

V. Phone/Fax

Practice location:
  • Phone: 207-649-7855
  • Fax: 207-465-2458
Mailing address:
  • Phone: 207-649-7855
  • Fax: 207-465-2458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP81524
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: