Provider Demographics
NPI:1669674800
Name:DAVIS, SCOTT MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MITCHELL
Last Name:DAVIS
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:GREEN MOUNTAIN TREATMENT CENTER
Practice Address - Street 2:244 HIGH WATCH ROAD
Practice Address - City:EFFINGHAM
Practice Address - State:NH
Practice Address - Zip Code:93882
Practice Address - Country:US
Practice Address - Phone:866-652-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLT-4145207R00000X
MEMD18688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine