Douglas Lee Kavanaugh, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA561 Issued in ME

Practice address

1 Northeast Dr
Emmc - Northeast Cardiology Associates
Bangor, ME 04401

Phone

(207) 275-3800

Fax

(207) 275-3803

NPI assigned

May 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northeast Cardiology Associates

  • Cardiovascular Disease Physician
  • Bangor, ME
  • NPI 1417908302
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1447201165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 WHITING HILL RD",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "04412",
            "telephone_number": "207-973-5035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 NORTHEAST DR",
            "address_2": "EMMC - NORTHEAST CARDIOLOGY ASSOCIATES",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04401",
            "telephone_number": "207-275-3800",
            "fax_number": "207-275-3803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAVANAUGH",
        "first_name": "DOUGLAS",
        "middle_name": "LEE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ME",
            "license": "PA561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katahdin Valley Health Center
• Kathryn Wight
• Kimberly S Kauffman, M.D.
• Brian E Kaufman, DO
• Sunmeet Kaur, MD
• Takeo Kawamura, MD
• Peter Keebler, M.D.
• George Keefe, CADC
• John Aloysius Keefe, PH.D.
• Susan Keeffe

• Medical Physician Assistant in Bangor, ME
• Providers in Bangor, ME by specialty
• Medical Physician Assistant in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.