Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 008618 | ME |
Y | 207L00000X | Anesthesiologist | ME85406 | FL |
NPI | 1003818923 |
---|---|
Provider Name | Bhavagan S Maganti |
First Address | South Portland, ME 04106-3266 |
Second Address | Auburn, ME 04210-3922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 12/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29222 | FL BCBS PROVIDER # (01) | FL |
297670099 | (05) | ME |
300803700 | DOL ACS (FECA) W/C (01) | FL |
D79266 | (02) | ME |
P00009748 | MEDICARE RAILROAD (01) | FL |