Healthcare Provider Details

I. General information

NPI: 1205924347
Provider Name (Legal Business Name): GWENDOLYN OGUIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MUSSEY RD SUITE 2
SCARBOROUGH ME
04074-9570
US

IV. Provider business mailing address

10 FOREST FALLS DR SUITE 2B
YARMOUTH ME
04096-6936
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-1333
  • Fax: 207-885-1337
Mailing address:
  • Phone: 207-846-8722
  • Fax: 207-846-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1134
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: