Healthcare Provider Details

I. General information

NPI: 1508559089
Provider Name (Legal Business Name): MATTHEW CHRISTIAN NANOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 UNION ST STE 12
BANGOR ME
04401-3054
US

IV. Provider business mailing address

360 BROADWAY
BANGOR ME
04401-3979
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7979
  • Fax: 207-947-9579
Mailing address:
  • Phone: 207-907-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO4381
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: