Healthcare Provider Details

I. General information

NPI: 1629257159
Provider Name (Legal Business Name): VANCE A ALOUPIS MDPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 07/09/2013
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:
Mailing address:
  • Phone: 207-947-6508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number014706
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number007472
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number20D0684479
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP081724
License Number StateME
# 5
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberR024428
License Number StateME

VIII. Authorized Official

Name: DR. VANCE A ALOUPIS
Title or Position: PRESIDENT
Credential: MD
Phone: 207-947-6508