Provider Demographics
NPI:1558472811
Name:RAND, MELANIE C (DO)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:C
Last Name:RAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3935
Mailing Address - Country:US
Mailing Address - Phone:207-333-1055
Mailing Address - Fax:
Practice Address - Street 1:15 MOLLISON WAY
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5805
Practice Address - Country:US
Practice Address - Phone:207-777-4440
Practice Address - Fax:207-755-4970
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM838601Medicare PIN