Provider Demographics
NPI:1124069851
Name:FAGLES, NINA ELANA (MD)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ELANA
Last Name:FAGLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:ELANA
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:84 KELLEY RD
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-3416
Mailing Address - Country:US
Mailing Address - Phone:207-944-8179
Mailing Address - Fax:
Practice Address - Street 1:84 KELLEY RD
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-3416
Practice Address - Country:US
Practice Address - Phone:207-866-4399
Practice Address - Fax:207-866-4538
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME014359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEG86556Medicare UPIN
MEMM7607Medicare ID - Type Unspecified