Healthcare Provider Details

I. General information

NPI: 1124437942
Provider Name (Legal Business Name): RODNEY J. VOISINE, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 JOHN ROBERTS RD B10
SOUTH PORTLAND ME
04106-6961
US

IV. Provider business mailing address

75 JOHN ROBERTS RD B10
SOUTH PORTLAND ME
04106-6961
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-7700
  • Fax: 207-774-7701
Mailing address:
  • Phone: 207-774-7700
  • Fax: 207-774-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number016302
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR028856
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number016302
License Number StateME

VIII. Authorized Official

Name: DR. RODNEY J. VOISINE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 207-774-7700