Basic Information
Provider Information
NPI: 1730441346
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HIGGINS
FirstName: ANGELA
MiddleName: YOUNG
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 96 CAMPUS DR
Address2:  
City: SCARBOROUGH
State: ME
PostalCode: 040747163
CountryCode: US
TelephoneNumber: 2078859905
FaxNumber:  
Practice Location
Address1: 96 CAMPUS DR
Address2:  
City: SCARBOROUGH
State: ME
PostalCode: 040747163
CountryCode: US
TelephoneNumber: 2078859905
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/10/2012
LastUpdateDate: 12/03/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/30/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X20400NHN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207RC0000XMD23495MEY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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