Provider Demographics
NPI:1063867489
Name:ROSSIGNOL, JARRYD (DO)
Entity Type:Individual
Prefix:
First Name:JARRYD
Middle Name:
Last Name:ROSSIGNOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-0040
Mailing Address - Country:US
Mailing Address - Phone:207-498-1124
Mailing Address - Fax:207-493-5340
Practice Address - Street 1:66 SPRUCE ST STE 4
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3241
Practice Address - Country:US
Practice Address - Phone:207-769-2025
Practice Address - Fax:207-764-0629
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-RES.LIC 52134390200000X
MEDO2904207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
14482470OtherCAQH PROVIDER NO.
FR8350617OtherDEA