Healthcare Provider Details

I. General information

NPI: 1780156117
Provider Name (Legal Business Name): ROSE M FUCHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2018
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FOUNDERS ST
PATTEN ME
04765-3080
US

IV. Provider business mailing address

17 FOUNDERS ST
PATTEN ME
04765-3080
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSE FUCHS
Title or Position: CEO
Credential: MD
Phone: 207-922-9102