1487638177 NPI number — DR. PAUL KLUGER M.D.

Table of content: DR. PAUL KLUGER M.D. (NPI 1487638177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487638177 NPI number — DR. PAUL KLUGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUGER
Provider First Name:
PAUL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1487638177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 WHITING HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWER
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04412-1005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-5000
Provider Business Mailing Address Fax Number:
207-973-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
885 UNION ST
Provider Second Line Business Practice Location Address:
SUITE 145
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-3083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-9595
Provider Business Practice Location Address Fax Number:
207-973-7898
Provider Enumeration Date:
12/06/2005

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: 207YX0007X , with the licence number:  012600 , 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: 002412 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1040656 . This is a "AETNA INDIV #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 620012901 . This is a "CIGNA INDIV #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 306530099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 040013980 . This is a "RAILROAD INDIV PROV #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 110570001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100224700 . This is a "DEPT OF LABOR GROUP #" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 110570000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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