1427003417 NPI number — MATS AGREN M.D.

Table of content: MATS AGREN M.D. (NPI 1427003417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427003417 NPI number — MATS AGREN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGREN
Provider First Name:
MATS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427003417
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 NORTHBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALMOUTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04105-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-781-4424
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 NORTHBROOK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALMOUTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04105-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-781-4424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  013728 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: MD13728 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1041014 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 30010728 . This is a "NH MEDICAID" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 034482 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1120990001 . This is a "DMERC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 260630099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200032053 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: F56356 . This is a "HARVARD PILGRIM HC" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: M84374 . This is a "CIGNA HEALTHSOURCE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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