Provider Demographics
NPI:1992763130
Name:DECAROLIS, HEATHER L (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L
Last Name:DECAROLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 WHITTIER RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6318
Mailing Address - Country:US
Mailing Address - Phone:207-779-1162
Mailing Address - Fax:
Practice Address - Street 1:111 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-6031
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1832207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI23879Medicare UPIN