Provider Demographics
NPI:1023165081
Name:PARE, MAURICE (DO)
Entity type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:PARE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5609
Mailing Address - Country:US
Mailing Address - Phone:207-941-4036
Mailing Address - Fax:207-941-4062
Practice Address - Street 1:656 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5609
Practice Address - Country:US
Practice Address - Phone:207-941-4036
Practice Address - Fax:207-941-4062
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1117208100000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME061193OtherANTHEM BC
MEF64380Medicaid
MEF64380Medicare UPIN
ME061193OtherANTHEM BC