Provider Demographics
NPI:1477513000
Name:GOULD, ROBERTA (CNM)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:GOULD
Suffix:
Gender:F
Credentials:CNM
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 233
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-0233
Mailing Address - Country:US
Mailing Address - Phone:207-459-7195
Mailing Address - Fax:207-459-7609
Practice Address - Street 1:25 JUNE ST
Practice Address - Street 2:SUITE 110
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073
Practice Address - Country:US
Practice Address - Phone:207-324-2147
Practice Address - Fax:207-324-1288
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER040848207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S47222Medicare UPIN
ME0427Medicare ID - Type Unspecified