1790358604 NPI number — AMANDA MCGINNIS BAKAIAN PHARMD

Table of content: AMANDA MCGINNIS BAKAIAN PHARMD (NPI 1790358604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790358604 NPI number — AMANDA MCGINNIS BAKAIAN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKAIAN
Provider First Name:
AMANDA
Provider Middle Name:
MCGINNIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOWER
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MCGINNIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790358604
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
264 ACADEMY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04259-7033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-620-2180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 VA CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04330-6795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-623-8411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2021

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: 183500000X , with the licence number:  PR5909 , 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)





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