Provider Demographics
NPI:1356542831
Name:BANG, STEVEN WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WAYNE
Last Name:BANG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7653
Mailing Address - Country:US
Mailing Address - Phone:207-795-5710
Mailing Address - Fax:207-795-2732
Practice Address - Street 1:10 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7653
Practice Address - Country:US
Practice Address - Phone:207-795-5710
Practice Address - Fax:207-795-2732
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45702208600000X
ME2122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME434577099Medicaid