1366447401 NPI number — SCOTT G AKIN MD

Table of content: SCOTT G AKIN MD (NPI 1366447401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366447401 NPI number — SCOTT G AKIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AKIN
Provider First Name:
SCOTT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366447401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
324 GANNETT DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PORTLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04106-3266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
72-482-7800
Provider Business Mailing Address Fax Number:
207-348-2178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 BRAMHALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04102-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-662-4735
Provider Business Practice Location Address Fax Number:
207-662-6388
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  MD28777 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: 01086974A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DR.0057079 . This is a "STATE LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 1366447401 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: MD-45451 . This is a "STATE LICENSE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 01086974A . This is a "STATE LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 30739 . This is a "STATE LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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