Provider Demographics
NPI:1457434573
Name:TREMBLAY, CHRISTINE M (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:M
Last Name:TREMBLAY
Suffix:
Gender:F
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:PO BOX 1089
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-1089
Mailing Address - Country:US
Mailing Address - Phone:207-646-0677
Mailing Address - Fax:
Practice Address - Street 1:59 MILE ROAD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090
Practice Address - Country:US
Practice Address - Phone:207-646-0677
Practice Address - Fax:207-646-0949
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MET0646207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME099788OtherANTHEM
MEMM9626OtherMEDICARE GROUP NUMBER
ME1134309511OtherGROUP NPI
ME$$$$$$$$$OtherSS#