1801880943 NPI number — DR. PETER A BRIDGMAN M.D.

Table of content: DR. PETER A BRIDGMAN M.D. (NPI 1801880943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801880943 NPI number — DR. PETER A BRIDGMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDGMAN
Provider First Name:
PETER
Provider Middle Name:
A
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:
1801880943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 626
Provider Second Line Business Mailing Address:
ONE MEDICAL CENTER DRIVE,
Provider Business Mailing Address City Name:
BIDDEFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-282-5509
Provider Business Mailing Address Fax Number:
207-284-8516

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26A WEST COLE ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-282-5509
Provider Business Practice Location Address Fax Number:
207-284-8516
Provider Enumeration Date:
09/06/2005

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: 2084N0400X , with the licence number:  MD12560 , 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: 1801880943 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1801880943 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 5459253 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 0962037 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: AA313278 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com