Provider Demographics
NPI:1356224547
Name:BRIDGEO, NATHANIEL JOSEPH (LADC, MHRT/C, BHP)
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:JOSEPH
Last Name:BRIDGEO
Suffix:
Gender:M
Credentials:LADC, MHRT/C, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 FINSON RD LOT 132
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2443
Mailing Address - Country:US
Mailing Address - Phone:207-401-0966
Mailing Address - Fax:
Practice Address - Street 1:6 STATE ST STE 513
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5163
Practice Address - Country:US
Practice Address - Phone:207-812-8372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC76002084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty