Most Relevant Information
Provider Data
| NPI Number: | 1003347899 |
| Provider Name: | DEREK POULIN DO |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/23/2017 |
| Last Updated: | 06/09/2022 |
Provider Practice Location
22 BRAMHALL ST
PORTLAND
ME
041023134
Practice Location Phone/Fax
| Phone: | 2076622526 |
| Fax: |
Provider Mailing Location
324 GANNETT DR STE 200
SOUTH PORTLAND
ME
041063266
Provider Mailing Phone/Fax
| Phone: | 2074827800 |
| Fax: |