Provider Demographics
NPI:1417977067
Name:REMICK, SCOT C (MD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:C
Last Name:REMICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 RIVERSIDE ST
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1073
Mailing Address - Country:US
Mailing Address - Phone:207-661-2000
Mailing Address - Fax:
Practice Address - Street 1:100 CAMPUS DR
Practice Address - Street 2:SUITE 121
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7171
Practice Address - Country:US
Practice Address - Phone:207-396-7760
Practice Address - Fax:207-396-8500
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-071269207RH0003X
MEMD20833207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307233Medicaid
WVCA7030OtherRAILROAD MEDICARE GROUP #
WVP00610972OtherRAILROAD MEDICARE
WV3810010113Medicaid
830004525OtherMCR RR
WVRE6036351Medicare PIN
WVP00610972OtherRAILROAD MEDICARE
WV3810010113Medicaid
MEE400284259Medicare PIN