Provider Demographics
NPI:1457449423
Name:SHOLL, ROBERT R (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:SHOLL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 WELLSPRING RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9401
Mailing Address - Country:US
Mailing Address - Phone:207-282-3369
Mailing Address - Fax:207-282-9920
Practice Address - Street 1:4 WELLSPRING RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9401
Practice Address - Country:US
Practice Address - Phone:207-282-3369
Practice Address - Fax:207-282-9920
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME008890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041129OtherAETNA
ME1970311OtherCIGNA
ME320250099Medicaid
B86999OtherHARVARD PILGRIM HEALTHCAR
ME027353OtherANTHEM
ME320250099Medicaid
MEB86699Medicare UPIN