National Provider Identifier Database

EVERGREEN GYNECOLOGY ASSOCIATES PA
Gynecology

A physician who specializes in diagnosis, treatment, and management of patients with gynecologic conditions.


Contact Information

EVERGREEN GYNECOLOGY ASSOCIATES, P.A.
700 MOUNT HOPE AVE
SUITE 430
BANGOR, ME04401-5691
Phone: 207-947-8658
Fax: 207-947-4440
Website:
Specialty Taxonomy Code
* Gynecology 207VG0400X

* Indicates primary specialty

NPI Profile & details for EVERGREEN GYNECOLOGY ASSOCIATES, P.A.

NPI Number 1629154463
Legal business name
LBN
EVERGREEN GYNECOLOGY ASSOCIATES, P.A.
Authorized official JANE LAEGER - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 10/27/2006
Last updated 10/16/2013 - About 13 years ago
Sole proprietor1 Not specified
Identifiers
  • ME License #: 011478
  • ME Medicaid: 115880000
  • ME Other: 726446 AETNA
  • ME Other: 000697 ANTHEM
  • ME Other: M63911 CIGNA

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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