Provider Demographics
NPI:1447267901
Name:BELANGER, PRISCILLE (CMF)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLE
Middle Name:
Last Name:BELANGER
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2590
Mailing Address - Country:US
Mailing Address - Phone:207-284-8614
Mailing Address - Fax:207-284-8614
Practice Address - Street 1:193 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2590
Practice Address - Country:US
Practice Address - Phone:207-284-8614
Practice Address - Fax:207-284-8614
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME19Z018028ME01OtherANTHEM
ME129570000Medicaid
ME1065450001Medicare ID - Type Unspecified