Provider Demographics
NPI:1619022423
Name:PARADIS, LORAINE (DO)
Entity Type:Individual
Prefix:DR
First Name:LORAINE
Middle Name:
Last Name:PARADIS
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 1:174 KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5134
Mailing Address - Country:US
Mailing Address - Phone:207-861-3338
Mailing Address - Fax:207-861-3281
Practice Address - Street 1:344 LAKEWOOD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950-3015
Practice Address - Country:US
Practice Address - Phone:207-474-2994
Practice Address - Fax:207-858-0201
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE69094Medicare UPIN
ME208506Medicare ID - Type UnspecifiedRURAL HEALTH PROVIDER