Active NPI
Evergreen Gynecology Associates, P.a.
- Gynecology Physician
- Bangor, ME
National Provider Identifier
1629154463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 011478
- Legal business name
- EVERGREEN GYNECOLOGY ASSOCIATES, P.A.
- Practice address
- 700 Mount Hope Ave
Suite 430
Bangor, ME 04401-5691 - Phone
- (207) 947-8658
- Fax
- (207) 947-4440
- NPI assigned
- Oct 27, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jane N. Laeger, M.D.
- Title
- Owner
- Phone
- (207) 947-8658
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 011478 | ME | Primary |
Addresses
Primary practice location
700 Mount Hope Ave
Suite 430
Bangor, ME 04401-5691
Mailing address
700 Mount Hope Ave
Suite 430
Bangor, ME 04401-5691
Phone (207) 947-8658
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 115880000 | Medicaid | ME | |
| 000697 | Other | ME | ANTHEM |
| M63911 | Other | ME | CIGNA |
| 726446 | Other | ME | AETNA |
National Provider Directory
National Provider DirectoryLocations
430 Evergreen Woods
Bangor, ME 04401
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1381881600000",
"number": "1629154463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 MOUNT HOPE AVE",
"address_2": "SUITE 430",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015691",
"telephone_number": "207-947-8658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 MOUNT HOPE AVE",
"address_2": "SUITE 430",
"city": "BANGOR",
"state": "ME",
"postal_code": "044015691",
"telephone_number": "207-947-8658",
"fax_number": "207-947-4440"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVERGREEN GYNECOLOGY ASSOCIATES, P.A.",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-27",
"last_updated": "2013-10-16",
"status": "A",
"authorized_official_last_name": "LAEGER",
"authorized_official_first_name": "JANE",
"authorized_official_middle_name": "N.",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "207-947-8658",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "ME",
"license": "011478",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "115880000",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000697",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "M63911",
"state": "ME"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "726446",
"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 Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.