Provider Demographics
NPI:1992117204
Name:LAMOREAU, BRYAN ANDREW (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:ANDREW
Last Name:LAMOREAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8897
Mailing Address - Country:US
Mailing Address - Phone:207-883-7926
Mailing Address - Fax:
Practice Address - Street 1:300 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8897
Practice Address - Country:US
Practice Address - Phone:207-883-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine