Provider Demographics
NPI:1144214271
Name:ALESSI, CARL F (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:ALESSI
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0068
Mailing Address - Country:US
Mailing Address - Phone:207-794-3296
Mailing Address - Fax:207-794-8072
Practice Address - Street 1:252 ENFIELD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-4146
Practice Address - Country:US
Practice Address - Phone:207-794-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME125050000Medicaid
MM4574Medicare ID - Type Unspecified
ME125050000Medicaid