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General NPI Number Information
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NPI Number | 1720068703
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Entity Type | Individual
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Provider Name | SUSAN GAYLORD
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Gender | Female
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 11/09/2010
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Provider Practice Location Address
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Address Line | 287 MAIN ST STE 201
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City | LEWISTON
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State | ME
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Zip | 04240-7054
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Country | US
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Telephone | 207-795-7180
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Fax | 207-795-7179
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Provider Business Mailing Address
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Address Line | 287 MAIN ST STE 201
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City | LEWISTON
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State | ME
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Zip | 04240-7054
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Country | US
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Telephone | 207-795-7180
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Fax | 207-795-7179
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 12540
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License Number State | ME
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