Healthcare Provider Details

I. General information

NPI: 1689697708
Provider Name (Legal Business Name): PATRICK T MAILLOUX DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106-2327
US

IV. Provider business mailing address

100 FODEN RD STE 103
SOUTH PORTLAND ME
04106-2327
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1122
  • Fax: 207-828-0188
Mailing address:
  • Phone: 207-828-1122
  • Fax: 207-828-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberDO2770
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: