=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437592995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VASAVI PAIDPALLY M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2013
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 489 STATE ST
-----------------------------------------------------
City | BANGOR
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04401-6616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-973-5979
-----------------------------------------------------
Fax | 207-956-6676
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 324 GANNETT DR STE 200
-----------------------------------------------------
City | SOUTH PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04106-3266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-482-7861
-----------------------------------------------------
Fax | 207-482-7861
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | 02170
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD22625
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------