Provider Demographics
NPI:1588623375
Name:OUELLETTE, PATRICIA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LYNN
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:P LYNN
Other - Middle Name:
Other - Last Name:OUELLETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:80 RAYMOND RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7359
Mailing Address - Country:US
Mailing Address - Phone:207-721-0080
Mailing Address - Fax:207-406-4791
Practice Address - Street 1:80 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7359
Practice Address - Country:US
Practice Address - Phone:207-721-0080
Practice Address - Fax:207-406-4791
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD125552084P0015X, 2084P0800X
ME125552084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME208340000Medicaid
B95337Medicare UPIN
ME208340000Medicaid