Provider Demographics
NPI:1285749085
Name:MCGOLDRICK, MICHAEL C (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:MCGOLDRICK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:SUITE 321
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-973-8833
Mailing Address - Fax:207-973-8836
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:SUITE 321
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-8833
Practice Address - Fax:207-973-8836
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME017221207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432325999Medicaid
MEI58512Medicare UPIN
ME2030Medicare UPIN