Healthcare Provider Details

I. General information

NPI: 1699770222
Provider Name (Legal Business Name): ROSE M FUCHS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FOUNDERS ST
PATTEN ME
04765
US

IV. Provider business mailing address

17 FOUNDERS ST
PATTEN ME
04765-3080
US

V. Phone/Fax

Practice location:
  • Phone: 207-992-9102
  • Fax: 207-922-9080
Mailing address:
  • Phone: 207-992-9102
  • Fax: 207-922-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD20092
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: