Provider Demographics
NPI:1003212648
Name:JOHN R. MCGILL, MD PA
Entity Type:Organization
Organization Name:JOHN R. MCGILL, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-947-4555
Mailing Address - Street 1:436A STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6606
Mailing Address - Country:US
Mailing Address - Phone:207-947-4555
Mailing Address - Fax:207-947-3619
Practice Address - Street 1:436A STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6606
Practice Address - Country:US
Practice Address - Phone:207-947-4555
Practice Address - Fax:207-947-3619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009457174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED79254Medicare UPIN