Provider Demographics
NPI:1427003417
Name:AGREN, MATS (MD)
Entity Type:Individual
Prefix:
First Name:MATS
Middle Name:
Last Name:AGREN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1318
Mailing Address - Country:US
Mailing Address - Phone:207-781-4424
Mailing Address - Fax:
Practice Address - Street 1:20 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1318
Practice Address - Country:US
Practice Address - Phone:207-781-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013728207X00000X
MEMD13728207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1041014OtherAETNA
ME30010728OtherNH MEDICAID
ME034482OtherANTHEM
ME1120990001OtherDMERC
ME260630099Medicaid
ME200032053OtherRAILROAD MEDICARE
MEF56356OtherHARVARD PILGRIM HC
MEM84374OtherCIGNA HEALTHSOURCE
ME30010728OtherNH MEDICAID