Provider Demographics
NPI:1164565552
Name:SCHILLING, TRACI B (MD)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:B
Last Name:SCHILLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:B
Other - Last Name:DEPALMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:180 KENNEDY MEMORIAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4540
Mailing Address - Country:US
Mailing Address - Phone:207-861-7050
Mailing Address - Fax:207-861-7056
Practice Address - Street 1:180 KENNEDY MEMORIAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4540
Practice Address - Country:US
Practice Address - Phone:207-861-7050
Practice Address - Fax:207-861-7056
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0181722084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2134021Medicaid
ME434423499Medicaid
VT1013587Medicaid
ME000066304Medicare PIN
MA000066303Medicare PIN
MA2134021Medicaid
NYRB4081Medicare PIN