Provider Demographics
NPI:1063566925
Name:KIRBY-LONG, PAULA CLAIRE (MD)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:CLAIRE
Last Name:KIRBY-LONG
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 1:76 HIGH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7591
Mailing Address - Country:US
Mailing Address - Phone:207-795-5544
Mailing Address - Fax:207-795-5645
Practice Address - Street 1:76 HIGH ST STE 300
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7591
Practice Address - Country:US
Practice Address - Phone:207-795-5544
Practice Address - Fax:207-795-5645
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT04200100742084P0800X
ME0180392084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN2404Medicaid
VTH26253Medicare UPIN