Provider Demographics
NPI:1801880943
Name:BRIDGMAN, PETER A (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:BRIDGMAN
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:PO BOX 626
Mailing Address - Street 2:ONE MEDICAL CENTER DRIVE,
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005
Mailing Address - Country:US
Mailing Address - Phone:207-282-5509
Mailing Address - Fax:207-284-8516
Practice Address - Street 1:26A WEST COLE ROAD
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005
Practice Address - Country:US
Practice Address - Phone:207-282-5509
Practice Address - Fax:207-284-8516
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD125602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1801880943Medicaid
ME1801880943OtherANTHEM
ME5459253OtherAETNA
ME0962037OtherCIGNA
MEAA313278OtherHARVARD PILGRIM
ME0962037OtherCIGNA
MEAA313278OtherHARVARD PILGRIM