Provider Demographics
NPI:1902831035
Name:QUIGLEY, BERNARD J (MD)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:QUIGLEY
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 1:59 MILES RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:ME
Mailing Address - Zip Code:04444-4732
Mailing Address - Country:US
Mailing Address - Phone:207-941-4398
Mailing Address - Fax:207-941-4062
Practice Address - Street 1:656 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5609
Practice Address - Country:US
Practice Address - Phone:207-941-4036
Practice Address - Fax:207-941-4062
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0150432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI47639Medicare UPIN
MEME1752Medicare ID - Type Unspecified