Healthcare Provider Details

I. General information

NPI: 1447781513
Provider Name (Legal Business Name): MEREDITH GWYN BANIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHAPE DR
KENNEBUNK ME
04043-6601
US

IV. Provider business mailing address

3 SHAPE DR
KENNEBUNK ME
04043-6601
US

V. Phone/Fax

Practice location:
  • Phone: 207-467-8930
  • Fax: 207-985-8459
Mailing address:
  • Phone: 207-467-8930
  • Fax: 207-985-8459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20546
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD30953
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: