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General NPI Number Information
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NPI Number | 1356224547
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Entity Type | Individual
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Provider Name | NATHANIEL JOSEPH BRIDGEO LADC, MHRT/C, BHP
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Gender | Male
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 6 STATE ST STE 513
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City | BANGOR
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State | ME
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Zip | 04401-5163
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Country | US
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Telephone | 207-812-8372
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Fax |
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Provider Business Mailing Address
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Address Line | 666 FINSON RD LOT 132
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City | BANGOR
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State | ME
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Zip | 04401-2443
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Country | US
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Telephone | 207-401-0966
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | LC7600
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License Number State | ME
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