Provider Demographics
NPI:1699770222
Name:FUCHS, ROSE M (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:M
Last Name:FUCHS
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 1:17 FOUNDERS ST
Mailing Address - Street 2:
Mailing Address - City:PATTEN
Mailing Address - State:ME
Mailing Address - Zip Code:04765-3080
Mailing Address - Country:US
Mailing Address - Phone:207-992-9102
Mailing Address - Fax:207-922-9080
Practice Address - Street 1:17 FOUNDERS ST
Practice Address - Street 2:
Practice Address - City:PATTEN
Practice Address - State:ME
Practice Address - Zip Code:04765
Practice Address - Country:US
Practice Address - Phone:207-992-9102
Practice Address - Fax:207-922-9080
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD20092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA359228115Medicaid
GA359228115Medicaid
GA08BBQRVMedicare ID - Type Unspecified