Organization
BANGOR SURGICAL ASSOCIATES, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN F VANADIA D.O. (OWNER/PRESIDENT)
(207) 947-5503
Entity
Organization
Contact information
Practice address
358 BROADWAY, SUITE 306, BANGOR, ME 04401-3929
(207) 947-5503
(207) 947-8578
Mailing address
358 BROADWAY, SUITE 306, BANGOR, ME 04401-3929
(207) 947-5503
(207) 947-8578
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
1149
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040754
ANTHEM BS PROVIDER #
ME
05
—
134040000
—
ME
01
—
2677016
CIGNA PROVIDER NUMBER
ME
Enumeration date
12/09/2005
Last updated
12/15/2010
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