Healthcare Provider Details

I. General information

NPI: 1184989899
Provider Name (Legal Business Name): MICHAEL VINOGRAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 HOSPITAL DR
BRIDGTON ME
04009-1167
US

IV. Provider business mailing address

25 HOSPITAL DR
BRIDGTON ME
04009-1167
US

V. Phone/Fax

Practice location:
  • Phone: 207-647-4232
  • Fax: 207-647-6016
Mailing address:
  • Phone: 207-647-4232
  • Fax: 207-647-6016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD20901
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD20901
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: