Provider Demographics
NPI:1043348733
Name:JUBINVILLE, PAT
Entity Type:Individual
Prefix:MRS
First Name:PAT
Middle Name:
Last Name:JUBINVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CIDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:ME
Mailing Address - Zip Code:04435-3011
Mailing Address - Country:US
Mailing Address - Phone:207-379-3148
Mailing Address - Fax:
Practice Address - Street 1:280 CIDER HILL RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:ME
Practice Address - Zip Code:04435-3011
Practice Address - Country:US
Practice Address - Phone:207-379-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1364305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME215780000Medicaid