Provider Demographics
NPI:1114171857
Name:SCOPAZ, KRISTEN ALYSE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ALYSE
Last Name:SCOPAZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MUSSEY RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9570
Mailing Address - Country:US
Mailing Address - Phone:207-885-1333
Mailing Address - Fax:207-885-1332
Practice Address - Street 1:20 MUSSEY RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9570
Practice Address - Country:US
Practice Address - Phone:207-885-1333
Practice Address - Fax:207-885-1332
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19333207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP01114974Medicare PIN
ME002937703Medicare PIN
ME002937702Medicare PIN
ME002937701Medicare PIN