Basic Information
| Provider Information | |||||||||
| NPI: | 1750549044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MANAGES | ||||||||
| FirstName: | SAMUELA | ||||||||
| MiddleName: | EUDORA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047360040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074982359 | ||||||||
| FaxNumber: | 2074983947 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 EVERETT AVE | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021501812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178848302 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2008 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 017911 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QA0401X | MD17911 | ME | N | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | 207Q00000X | 291194 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.