Provider Demographics
NPI:1619967361
Name:HAINES, ALICE C (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:HAINES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:L
Other - Last Name:CHARTRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:60 PINE ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7214
Mailing Address - Country:US
Mailing Address - Phone:207-212-9948
Mailing Address - Fax:
Practice Address - Street 1:60 PINE ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7214
Practice Address - Country:US
Practice Address - Phone:207-212-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86626Medicare UPIN
MM7903Medicare ID - Type Unspecified