Provider Demographics
NPI:1629187893
Name:AUCOIN, JENNIFER M (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:M
Last Name:AUCOIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 SAINT ANDREWS LN
Mailing Address - Street 2:
Mailing Address - City:BOOTHBAY HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04538-1732
Mailing Address - Country:US
Mailing Address - Phone:207-633-7820
Mailing Address - Fax:
Practice Address - Street 1:19 SAINT ANDREWS LN
Practice Address - Street 2:
Practice Address - City:BOOTHBAY HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04538-1732
Practice Address - Country:US
Practice Address - Phone:207-633-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8HD457Medicare ID - Type UnspecifiedID NUMBER FOR HSZ168
AZI27026Medicare UPIN
AZ8HD458Medicare ID - Type UnspecifiedID NUMBER FOR HSZ169
AZ8HD458Medicare ID - Type UnspecifiedID NUMBER FOR HSZ169