Provider Demographics
NPI:1487689675
Name:ADLER, CONSTANCE A (MD, FAAFP)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:A
Last Name:ADLER
Suffix:
Gender:F
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FRANKLIN HEALTH CMNS
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6144
Mailing Address - Country:US
Mailing Address - Phone:207-778-0804
Mailing Address - Fax:207-778-2886
Practice Address - Street 1:181 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-0804
Practice Address - Fax:207-778-2886
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME292680099Medicaid
MEA07799Medicare UPIN
MEMM0732Medicare ID - Type Unspecified
ME292680099Medicaid