Provider Demographics
NPI:1831186741
Name:MAPES, RAELENE A (DO)
Entity type:Individual
Prefix:
First Name:RAELENE
Middle Name:A
Last Name:MAPES
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 11450
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4005
Mailing Address - Country:US
Mailing Address - Phone:479-709-1924
Mailing Address - Fax:479-709-7499
Practice Address - Street 1:209 POINTER TRL W
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2238
Practice Address - Country:US
Practice Address - Phone:479-474-3399
Practice Address - Fax:479-474-2338
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2256208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100218960AMedicaid
AR216390003Medicaid
AR216390003Medicaid
AR5AB68Medicare PIN