MEDICARE: DR. MANUEL GONZALES SANGALANG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	007097	ME

General Provider Information

NPI Number	:	1992843015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL GONZALES SANGALANG MD

Provider Business Mailing Address
First Line	:	111 WEBSTER ST
Second Line	:	SUITE #4
City	:	LEWISTON
State	:	ME
Zip	:	04240-6464
Country	:	US
Telephone Number	:	207-782-6021
Fax Number	:	207-782-6021

Provider Business Practice Location Address
First Line	:	111 WEBSTER ST
Second Line	:	SUITE #4
City	:	LEWISTON
State	:	ME
Zip	:	04240-6464
Country	:	US
Telephone Number	:	207-782-6021
Fax Number	:	207-782-6021

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	12/14/2025

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