Provider Demographics
NPI: | 1942795885 |
---|---|
Name: | BANKS PAULINO, ANGELA ROSALIA (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | ANGELA |
Middle Name: | ROSALIA |
Last Name: | BANKS PAULINO |
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: | PO BOX 468 |
Mailing Address - Street 2: | |
Mailing Address - City: | SKOWHEGAN |
Mailing Address - State: | ME |
Mailing Address - Zip Code: | 04976-0468 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 207-474-0905 |
Mailing Address - Fax: | 207-474-6930 |
Practice Address - Street 1: | 46 FAIRVIEW AVE STE 111 |
Practice Address - Street 2: | |
Practice Address - City: | SKOWHEGAN |
Practice Address - State: | ME |
Practice Address - Zip Code: | 04976-1481 |
Practice Address - Country: | US |
Practice Address - Phone: | 207-474-0905 |
Practice Address - Fax: | 207-474-6930 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-06-23 |
Last Update Date: | 2023-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
ME | MD25815 | 207RH0002X, 207R00000X |
390200000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |