Provider Demographics
NPI:1720095862
Name:GABRIELSEN, ERIC RICHARD
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RICHARD
Last Name:GABRIELSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294
Mailing Address - Country:US
Mailing Address - Phone:207-645-4060
Mailing Address - Fax:
Practice Address - Street 1:1 VA CENTER
Practice Address - Street 2:
Practice Address - City:TOGUS
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-8411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METC12502278G1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278G1100XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGeneral Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
METC1250OtherCRT