Provider Demographics
NPI:1790903961
Name:MANUEL SANGALANG
Entity Type:Organization
Organization Name:MANUEL SANGALANG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGALANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-782-6021
Mailing Address - Street 1:111 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6464
Mailing Address - Country:US
Mailing Address - Phone:207-782-6021
Mailing Address - Fax:207-782-6021
Practice Address - Street 1:111 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6464
Practice Address - Country:US
Practice Address - Phone:207-782-6021
Practice Address - Fax:207-782-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME007097207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB86954Medicare UPIN
ME119520Medicare ID - Type Unspecified