Healthcare Provider Details

I. General information

NPI: 1144723289
Provider Name (Legal Business Name): ANDREW T BAGBY MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 GOODRICH AVE
KITTERY ME
03904
US

IV. Provider business mailing address

402 GOODRICH AVE
KITTERY ME
03904
US

V. Phone/Fax

Practice location:
  • Phone: 207-468-5981
  • Fax:
Mailing address:
  • Phone: 207-438-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number0101267432
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: