Provider Demographics
NPI:1821257650
Name:FREDRICKS-REHAGEN, CATHERINE R (DO)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:R
Last Name:FREDRICKS-REHAGEN
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 1:108 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2550
Mailing Address - Country:US
Mailing Address - Phone:207-386-1800
Mailing Address - Fax:207-386-1801
Practice Address - Street 1:108 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2550
Practice Address - Country:US
Practice Address - Phone:207-386-1800
Practice Address - Fax:207-386-1801
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2231207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
12297912OtherCAQH
12297912OtherCAQH