Provider Demographics
NPI:1821060351
Name:GOFFIN, SCOTT L (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:GOFFIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:17 TACONIC AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1709
Mailing Address - Country:US
Mailing Address - Phone:413-528-5184
Mailing Address - Fax:413-528-4069
Practice Address - Street 1:780 MAIN ST
Practice Address - Street 2:SUITE 9
Practice Address - City:GREAT BARRINGTON
Practice Address - State:MA
Practice Address - Zip Code:01230-2148
Practice Address - Country:US
Practice Address - Phone:413-528-5184
Practice Address - Fax:413-528-1077
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2077441207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2062763/9730940Medicaid
MAH55849Medicare UPIN
SX2645Medicare PIN
A36824/M21498Medicare ID - Type Unspecified