Healthcare Provider Details

I. General information

NPI: 1508263112
Provider Name (Legal Business Name): VANCE A. ALOUPIS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2014
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 STATE ST
BANGOR ME
04401-5610
US

IV. Provider business mailing address

792 STATE ST
BANGOR ME
04401-5610
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-6508
  • Fax: 207-941-8342
Mailing address:
  • Phone: 207-947-6508
  • Fax: 207-941-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD7472
License Number StateME

VIII. Authorized Official

Name: DR. VANCE A ALOUPIS
Title or Position: OWNER
Credential: M.D.
Phone: 207-947-6508