Provider Demographics
NPI:1316196264
Name:MEDLAB792
Entity Type:Organization
Organization Name:MEDLAB792
Other - Org Name:VANCE A ALOUPIS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALOUPIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-947-6805
Mailing Address - Street 1:792 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5610
Mailing Address - Country:US
Mailing Address - Phone:207-947-6508
Mailing Address - Fax:207-941-8342
Practice Address - Street 1:792 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5610
Practice Address - Country:US
Practice Address - Phone:207-947-6508
Practice Address - Fax:207-941-8342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME20D0681466291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
000390OtherANTHEM