Healthcare Provider Details

I. General information

NPI: 1417042029
Provider Name (Legal Business Name): ROBERT A FAUCETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SCAMMON ST SUITE 51
SACO ME
04072-5121
US

IV. Provider business mailing address

301C US ROUTE 1
SCARBOROUGH ME
04074-9701
US

V. Phone/Fax

Practice location:
  • Phone: 207-282-3327
  • Fax:
Mailing address:
  • Phone: 207-396-8600
  • Fax: 207-396-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD11041
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: