Provider Demographics
NPI:1881660074
Name:GLEATON, MAROULLA (MD)
Entity Type:Individual
Prefix:
First Name:MAROULLA
Middle Name:
Last Name:GLEATON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5951
Mailing Address - Country:US
Mailing Address - Phone:207-622-3185
Mailing Address - Fax:207-622-5697
Practice Address - Street 1:227 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5951
Practice Address - Country:US
Practice Address - Phone:207-622-3185
Practice Address - Fax:207-622-5697
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012370207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME106370000Medicaid
MED88005Medicare UPIN
MEMM2360Medicare ID - Type UnspecifiedMEDICARE