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General NPI Number Information
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NPI Number | 1881679116
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Entity Type | Organization
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Legal Business Name | BANGOR SURGICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 12/09/2005
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 358 BROADWAY SUITE 306
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City | BANGOR
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State | ME
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Zip | 04401-3929
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Country | US
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Telephone | 207-947-5503
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Fax | 207-947-8578
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Provider Business Mailing Address
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Address Line | 358 BROADWAY SUITE 306
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City | BANGOR
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State | ME
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Zip | 04401-3929
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Country | US
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Telephone | 207-947-5503
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Fax | 207-947-8578
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JOHN F VANADIA
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Credential | D.O.
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Telephone | 207-947-5503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 1149
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License Number State | ME
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