Provider Demographics
NPI:1831294107
Name:SARDINA, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:SARDINA
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 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-7000
Mailing Address - Fax:
Practice Address - Street 1:915 UNION ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-8602
Practice Address - Country:US
Practice Address - Phone:207-973-8030
Practice Address - Fax:207-973-6005
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME119411700OtherFEDERAL W/C GROUP
ME273680099Medicaid
ME098991OtherANTHEM STAR
ME2805818OtherCIGNA PROVIDER NUMBER
ME144828OtherAETNA GROUP
ME203814OtherNHIC GROUP PTAN
MEMM5009Medicare PIN
ME203814OtherNHIC GROUP PTAN