Basic Information
| Provider Information | |||||||||
| NPI: | 1215902028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENLEAF | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 77 SEWALL ST | ||||||||
| Address2: | AUGUSTA FAMILY PHYSICIANS | ||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043306328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076225902 | ||||||||
| FaxNumber: | 2076234585 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 SEWALL ST | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043306328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076225902 | ||||||||
| FaxNumber: | 2076234585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 08/01/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01577 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 253900099 | 05 | ME | MEDICAID |