Provider Demographics
NPI:1568979631
Name:SCARBOROUGH INTEGRATIVE HEALTH, P.A.
Entity Type:Organization
Organization Name:SCARBOROUGH INTEGRATIVE HEALTH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-396-1440
Mailing Address - Street 1:51 US ROUTE 1 STE A
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7145
Mailing Address - Country:US
Mailing Address - Phone:207-396-1440
Mailing Address - Fax:207-289-3104
Practice Address - Street 1:51 US ROUTE 1 STE A
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7145
Practice Address - Country:US
Practice Address - Phone:207-396-1440
Practice Address - Fax:207-289-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD17055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty