Provider Demographics
NPI:1205031788
Name:RAINFORTH, DOUGLAS W (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:W
Last Name:RAINFORTH
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 693
Mailing Address - Street 2:
Mailing Address - City:MOODY
Mailing Address - State:ME
Mailing Address - Zip Code:04054-0693
Mailing Address - Country:US
Mailing Address - Phone:207-646-4475
Mailing Address - Fax:207-646-4475
Practice Address - Street 1:GOODALL OCCUPATIONAL HEALTH CLINIC
Practice Address - Street 2:13JULY ST.
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-490-7099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME6898174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME6898OtherMEDICAL LICENSE NUMBER