Provider Demographics
NPI:1730151697
Name:FULL CIRCLE FAMILY MEDICINE
Entity type:Organization
Organization Name:FULL CIRCLE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-563-6623
Mailing Address - Street 1:68 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4614
Mailing Address - Country:US
Mailing Address - Phone:207-563-6623
Mailing Address - Fax:207-563-6625
Practice Address - Street 1:68 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-6623
Practice Address - Fax:207-563-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DB6295OtherRAILROAD MEDICARE
ME185020000Medicaid
MEME0255Medicare ID - Type UnspecifiedMEDICIARE