Provider Demographics
NPI:1629257159
Name:VANCE A ALOUPIS MDPA
Entity Type:Organization
Organization Name:VANCE A ALOUPIS MDPA
Other - Org Name:
Other - Org Type:
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:207-947-6508
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007472173000000X
ME014706174400000X
ME20D0684479291U00000X
MER024428363AS0400X
MEAP081724363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME25765OtherANTHEM
MENP1390Medicare PIN
ME015168Medicare PIN
ME25765OtherANTHEM
MELA208103Medicare PIN
MEVA001970Medicare PIN