Healthcare Provider Details

I. General information

NPI: 1750340154
Provider Name (Legal Business Name): CATHERINE ANNE LOCKWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PARK RD
WESTBROOK ME
04092-3188
US

IV. Provider business mailing address

40 PARK RD
WESTBROOK ME
04092-3188
US

V. Phone/Fax

Practice location:
  • Phone: 207-857-8174
  • Fax: 207-857-8410
Mailing address:
  • Phone: 207-857-8174
  • Fax: 207-857-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number016180
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: