Provider Demographics
NPI:1649216086
Name:GOSSELIN, PAUL GABRIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GABRIEL
Last Name:GOSSELIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:147 RIVERSIDE DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-623-6355
Mailing Address - Fax:207-622-0853
Practice Address - Street 1:147 RIVERSIDE DRIVE
Practice Address - Street 2:SUITE 1
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-6355
Practice Address - Fax:207-622-0853
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1631207R00000X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME030622895OtherCHAMPUS
ME175350000Medicaid
ME175350000Medicaid
MM7829Medicare UPIN