Provider Demographics
NPI:1134142227
Name:GILLADOGA, ANGLEA C (MD)
Entity Type:Individual
Prefix:
First Name:ANGLEA
Middle Name:C
Last Name:GILLADOGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6630
Mailing Address - Country:US
Mailing Address - Phone:207-942-4108
Mailing Address - Fax:207-973-8817
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6630
Practice Address - Country:US
Practice Address - Phone:207-942-4108
Practice Address - Fax:207-973-8817
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0084562080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86706Medicare UPIN
ME033246Medicare ID - Type Unspecified