Provider Demographics
NPI:1215902028
Name:GREENLEAF, PAULA W (DO)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:W
Last Name:GREENLEAF
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 1:77 SEWALL ST
Mailing Address - Street 2:AUGUSTA FAMILY PHYSICIANS
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6328
Mailing Address - Country:US
Mailing Address - Phone:207-622-5902
Mailing Address - Fax:207-623-4585
Practice Address - Street 1:77 SEWALL ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6328
Practice Address - Country:US
Practice Address - Phone:207-622-5902
Practice Address - Fax:207-623-4585
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME01577207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME253900099Medicaid
MEG68819Medicare UPIN
ME080120638Medicare PIN
ME253900099Medicaid