Provider Demographics
NPI:1881846079
Name:POULIN, STEPHEN C (CFA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:POULIN
Suffix:
Gender:M
Credentials:CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:EAST VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04935-0009
Mailing Address - Country:US
Mailing Address - Phone:207-680-6280
Mailing Address - Fax:
Practice Address - Street 1:89 FIRE RD. 9
Practice Address - Street 2:
Practice Address - City:CHINA
Practice Address - State:ME
Practice Address - Zip Code:04358
Practice Address - Country:US
Practice Address - Phone:207-680-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME108732246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant