Healthcare Provider Details

I. General information

NPI: 1154246817
Provider Name (Legal Business Name): PALLAVI MADANNAGARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 UNION ST STE 12
BANGOR ME
04401-3054
US

IV. Provider business mailing address

43 WHITING HILL RD STE 350
BREWER ME
04412-1020
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-7979
  • Fax: 207-947-9579
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: