Active NPI
Kenneth G Nadeau, PAC
- Physician Assistant
- Bangor, ME
National Provider Identifier
1003916388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA94
- Practice address
- 1068 Union St
Bangor, ME 04401-3016 - Phone
- (207) 404-8181
- Fax
- (207) 922-4198
- NPI assigned
- Sep 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA94 | ME | Primary |
Addresses
Primary practice location
1068 Union St
Bangor, ME 04401-3016
Mailing address
PO Box 1599
Bangor, ME 04402-1599
Phone (207) 945-5247
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 263400099 | Medicaid | ME |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA94 | ME | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620172800000",
"number": "1003916388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1599",
"city": "BANGOR",
"state": "ME",
"postal_code": "044021599",
"telephone_number": "207-945-5247",
"fax_number": "207-947-0435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1068 UNION ST",
"city": "BANGOR",
"state": "ME",
"postal_code": "044013016",
"telephone_number": "207-404-8181",
"fax_number": "207-922-4198"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NADEAU",
"first_name": "KENNETH",
"middle_name": "G",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-25",
"last_updated": "2021-05-05",
"certification_date": "2021-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ME",
"license": "PA94",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "263400099",
"state": "ME"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bangor, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.