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Individual

JEAN MARIE ANTONUCCI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
115 MT BLUE CIR, STE 2, FARMINGTON, ME 04938-6239
(207) 778-3313
(207) 778-3544
Mailing address
115 MT BLUE CIR, STE 2, FARMINGTON, ME 04938-6239
(207) 778-3313
(207) 778-3544

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12782
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
048285
ANTHEM
ME
01
12782
STATE LISENSE
ME
05
298980000
ME
Enumeration date
06/27/2005
Last updated
11/15/2011
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