Provider Demographics
NPI:1629202676
Name:RULF, JOANNA (DO)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:RULF
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 S FREEPORT RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6160
Mailing Address - Country:US
Mailing Address - Phone:207-386-4895
Mailing Address - Fax:
Practice Address - Street 1:174 S FREEPORT RD STE 1A
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6160
Practice Address - Country:US
Practice Address - Phone:207-386-4895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2279207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP01103168Medicare PIN
ME002806802Medicare PIN
ME002806801Medicare PIN