Provider Demographics
NPI:1942214234
Name:KENNEBEC GASTROINTESTINAL ASSOC.
Entity Type:Organization
Organization Name:KENNEBEC GASTROINTESTINAL ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BAGGOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-621-1150
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:SUITE C-3
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5717
Mailing Address - Country:US
Mailing Address - Phone:207-621-1150
Mailing Address - Fax:207-626-1045
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:SUITE C-3
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-621-1150
Practice Address - Fax:207-626-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME12943000Medicaid
ME12943000Medicaid