1831294107 NPI number — JOSEPH ANTHONY SARDINA MD

Table of content: JOSEPH ANTHONY SARDINA MD (NPI 1831294107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831294107 NPI number — JOSEPH ANTHONY SARDINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARDINA
Provider First Name:
JOSEPH
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
Provider Name Suffix Text:
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:
1831294107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2019
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 STE 300
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:
04412-1006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-973-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-973-8030
Provider Business Practice Location Address Fax Number:
207-973-6005
Provider Enumeration Date:
09/13/2006

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: 207Q00000X , with the licence number:  013598 , 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: 119411700 . This is a "FEDERAL W/C GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 273680099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 098991 . This is a "ANTHEM STAR" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2805818 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 144828 . This is a "AETNA GROUP" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 203814 . This is a "NHIC GROUP PTAN" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com