Individual
SANDRA BAGWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102
(207) 662-2179
(207) 662-6326
Mailing address
190 RIVERSIDE ST, SUITE 6B, PORTLAND, ME 04103-1073
(207) 661-2000
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
012416
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
284390099
—
ME
Enumeration date
05/11/2007
Last updated
04/24/2017
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