Provider Demographics
NPI:1992712848
Name:PAUL R MAILHOT, MD, PA
Entity type:Organization
Organization Name:PAUL R MAILHOT, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:MAILHOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-783-7892
Mailing Address - Street 1:287 MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7054
Mailing Address - Country:US
Mailing Address - Phone:207-783-7892
Mailing Address - Fax:207-783-7802
Practice Address - Street 1:287 MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7054
Practice Address - Country:US
Practice Address - Phone:207-783-7892
Practice Address - Fax:207-783-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009456208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86861Medicare UPIN
ME152548Medicare ID - Type Unspecified