1477524387 NPI number — PRESTON H DALGLISH JR. MD

Table of content: PRESTON H DALGLISH JR. MD (NPI 1477524387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477524387 NPI number — PRESTON H DALGLISH JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALGLISH
Provider First Name:
PRESTON
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477524387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CAMPUS DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
SCARBOROUGH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04074-9692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-885-8394
Provider Business Mailing Address Fax Number:
207-282-7610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 W COLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005-9407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-282-1148
Provider Business Practice Location Address Fax Number:
207-286-9126
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  12061 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0119203 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0119203 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 017283 . This is a "ANTHEM BCBS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 123590099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1477524387 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01850778 . This is a "RR MEDIARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2041781 . This is a "AETNA HMO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30203358 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5349698 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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