Healthcare Provider Details

I. General information

NPI: 1457450041
Provider Name (Legal Business Name): INGRID EVE RUNDEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 HANCOCK ST SUITE 2D
BANGOR ME
04401-6573
US

IV. Provider business mailing address

304 HANCOCK ST SUITE 2D
BANGOR ME
04401-6573
US

V. Phone/Fax

Practice location:
  • Phone: 207-561-3651
  • Fax: 207-945-3175
Mailing address:
  • Phone: 207-561-3651
  • Fax: 207-945-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number144308
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG49892
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number39074
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD045554L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36027
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number12605
License Number StateME
# 7
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number12605
License Number StateME
# 8
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number144308
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberG49892
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number39074
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberMD045554L
License Number StatePA
# 12
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number36027
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: