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Individual

FREDERICK K POULIN JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3770
Mailing address
144 STATE ST, PORTLAND, ME 04101-3776
(207) 879-3770

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD10685
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
002368
ANTHEM
05
273490099
ME
05
30002365
NH
Enumeration date
06/23/2006
Last updated
05/31/2013
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