Provider Demographics
NPI:1912227604
Name:WILLARD, CAITLIN E (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:E
Last Name:WILLARD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 SPRING ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8926
Mailing Address - Country:US
Mailing Address - Phone:207-883-7926
Mailing Address - Fax:207-618-5021
Practice Address - Street 1:49 SPRING ST STE 101
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8926
Practice Address - Country:US
Practice Address - Phone:207-883-7926
Practice Address - Fax:207-618-5021
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400169580Medicare PIN
MEE400169588Medicare PIN
MEE400169584Medicare PIN