Provider Demographics
NPI:1699161059
Name:RHODUS, CECILIA MONIQUE (MD)
Entity type:Individual
Prefix:
First Name:CECILIA
Middle Name:MONIQUE
Last Name:RHODUS
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 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5758
Mailing Address - Country:US
Mailing Address - Phone:207-623-6500
Mailing Address - Fax:207-621-5504
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5758
Practice Address - Country:US
Practice Address - Phone:207-623-6500
Practice Address - Fax:207-621-5504
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137260208000000X, 2080P0006X
MEMD257642080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR3232267556Medicaid