Provider Demographics
NPI:1083694509
Name:RINALDI, CARMEN J (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:RINALDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SEWALL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2645
Mailing Address - Country:US
Mailing Address - Phone:207-775-3526
Mailing Address - Fax:
Practice Address - Street 1:50 SEWALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2645
Practice Address - Country:US
Practice Address - Phone:207-775-3526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48025207N00000X
AZ37487207N00000X
ME018037207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN660931700Medicaid
AZ290678Medicaid
ME433819099Medicaid
AZP00449606OtherRAILROAD MEDICARE
MN660931700Medicaid
AZZ119210Medicare PIN
AZ290678Medicaid