Healthcare Provider Details

I. General information

NPI: 1609813443
Provider Name (Legal Business Name): STEPHEN B PAULDING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 02/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 ROOSEVELT TRL
WINDHAM ME
04062-4821
US

IV. Provider business mailing address

21 QUIET LN
PORTLAND ME
04103-2269
US

V. Phone/Fax

Practice location:
  • Phone: 207-893-0290
  • Fax:
Mailing address:
  • Phone: 207-878-3288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number006371
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: