Individual
ELISSA J CHARBONNEAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
24 HAWTHORNE CIRCLE, YARMOUTH, ME 04096-8337
(207) 851-1724
Mailing address
301 US ROUTE ONE, BUILDING C, SCARBOROUGH, ME 04074-9701
(207) 396-8600
(207) 396-8632
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
1399
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218640049
—
ME
Enumeration date
09/12/2005
Last updated
02/18/2011
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