Provider Demographics
NPI:1851377238
Name:STOCKWELL, ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:STOCKWELL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2 LIVEWELL DR.
Mailing Address - Street 2:THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-6762
Mailing Address - Country:US
Mailing Address - Phone:207-985-7174
Mailing Address - Fax:207-985-1304
Practice Address - Street 1:2 LIVEWELL DR.
Practice Address - Street 2:THE MEDICAL GROUP DEPT. OF GOODALL HOSPITAL
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6762
Practice Address - Country:US
Practice Address - Phone:207-985-7174
Practice Address - Fax:207-985-1304
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2011-12-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ME1588207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME279450099Medicaid
MEP00110777OtherMEDICARE RR
ME279450099Medicaid
MEP00110777OtherMEDICARE RR