Provider Demographics
NPI:1912074253
Name:SHOLL, NOREEN M (MD)
Entity Type:Individual
Prefix:
First Name:NOREEN
Middle Name:M
Last Name:SHOLL
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 1:4 WELLSPRING RD
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9401
Mailing Address - Country:US
Mailing Address - Phone:207-282-3369
Mailing Address - Fax:207-282-9920
Practice Address - Street 1:4 WELLSPRING RD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9401
Practice Address - Country:US
Practice Address - Phone:207-282-3369
Practice Address - Fax:207-282-9920
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG34073OtherHARVARD PILGRIM
ME027354OtherANTHEM
ME312620099Medicaid
ME6878111OtherCIGNA
ME1042388OtherAETNA
MEG34073Medicare UPIN
MEMM6481Medicare PIN