1770557316 NPI number — SCOTT D SHULMAN MD

Table of content: SCOTT D SHULMAN MD (NPI 1770557316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770557316 NPI number — SCOTT D SHULMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHULMAN
Provider First Name:
SCOTT
Provider Middle Name:
D
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:
1770557316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 934
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04402-0934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-907-3339
Provider Business Mailing Address Fax Number:
207-907-1214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
358 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-907-3660
Provider Business Practice Location Address Fax Number:
207-907-3661
Provider Enumeration Date:
02/13/2006

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: 2084N0400X , with the licence number:  MD17268 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X , with the licence number: 57645 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 098569 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1951774 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 7327731 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 432392399 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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