Healthcare Provider Details

I. General information

NPI: 1881512846
Provider Name (Legal Business Name): BRENT TODORICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 MAINE ST
POLAND ME
04274-7325
US

IV. Provider business mailing address

4 HOPE DR
GORHAM ME
04038-2664
US

V. Phone/Fax

Practice location:
  • Phone: 207-998-4483
  • Fax:
Mailing address:
  • Phone: 207-272-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCNP261444
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: