Organization
EVERGREEN GYNECOLOGY ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE N. LAEGER M.D. (OWNER)
(207) 947-8658
Entity
Organization
Contact information
Practice address
700 MOUNT HOPE AVE, SUITE 430, BANGOR, ME 04401-5691
(207) 947-8658
(207) 947-4440
Mailing address
700 MOUNT HOPE AVE, SUITE 430, BANGOR, ME 04401-5691
(207) 947-8658
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
011478
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000697
ANTHEM
ME
05
—
115880000
—
ME
01
—
726446
AETNA
ME
01
—
M63911
CIGNA
ME
Enumeration date
10/27/2006
Last updated
10/16/2013
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