Provider Demographics
NPI:1609852946
Name:PAOLINI, CHARLOTTE (DO)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:
Last Name:PAOLINI
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 1:1250 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1884
Mailing Address - Country:US
Mailing Address - Phone:207-878-9610
Mailing Address - Fax:207-878-4941
Practice Address - Street 1:1250 FOREST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-1884
Practice Address - Country:US
Practice Address - Phone:207-878-9610
Practice Address - Fax:207-878-4941
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1350207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEM1077907OtherCIGNA
ME04-08809OtherEVERCARE
ME010211810015OtherTRICARE
ME060972OtherANTHEM
ME304990099Medicaid
MEP00049948OtherRAILROAD MEDICARE
MEP36372OtherHARVARD
MEM1077907OtherCIGNA
ME010211810015OtherTRICARE