Healthcare Provider Details

I. General information

NPI: 1356786925
Provider Name (Legal Business Name): GUSTAVO CHURRANGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HEALTHCARE DR STE 202
BIDDEFORD ME
04005-9450
US

IV. Provider business mailing address

9 HEALTHCARE DR STE 202
BIDDEFORD ME
04005-9450
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-1427
  • Fax: 207-294-3554
Mailing address:
  • Phone: 207-283-1427
  • Fax: 207-294-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number266081
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD23996
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number266081
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD23996
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: