Provider Demographics
NPI:1801201967
Name:GRACIA, CHELSEY MARIE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHELSEY
Middle Name:MARIE
Last Name:GRACIA
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 1:417 STATE ST STE 439
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6635
Mailing Address - Country:US
Mailing Address - Phone:072-941-8200
Mailing Address - Fax:207-947-4061
Practice Address - Street 1:417 STATE ST STE 439
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6635
Practice Address - Country:US
Practice Address - Phone:072-941-8200
Practice Address - Fax:207-947-4061
Is Sole Proprietor?:No
Enumeration Date:2014-06-27
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016038207ZP0102X
MEDO3082207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEDO3082OtherMAINE BOARD OF OSTEOPATHIC LICENSURE