Provider Demographics
NPI:1306801444
Name:DECAROLIS, RICHARD J (DO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:DECAROLIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1367
Mailing Address - Street 2:32 RAILROAD ST
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217
Mailing Address - Country:US
Mailing Address - Phone:207-824-2193
Mailing Address - Fax:207-824-0012
Practice Address - Street 1:32 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217
Practice Address - Country:US
Practice Address - Phone:207-824-2193
Practice Address - Fax:207-824-0012
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61899Medicare UPIN
MM4899Medicare ID - Type Unspecified