Healthcare Provider Details

I. General information

NPI: 1902831035
Provider Name (Legal Business Name): BERNARD J QUIGLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 STATE ST
BANGOR ME
04401-5609
US

IV. Provider business mailing address

59 MILES RD
NEWBURGH ME
04444-4732
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-4036
  • Fax: 207-941-4062
Mailing address:
  • Phone: 207-941-4398
  • Fax: 207-941-4062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number015043
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: