Provider Demographics
NPI:1922132091
Name:WINN, GARY SCOTT (MPH, DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:SCOTT
Last Name:WINN
Suffix:
Gender:M
Credentials:MPH, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 W COLE RD STE C
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9428
Mailing Address - Country:US
Mailing Address - Phone:207-286-2273
Mailing Address - Fax:207-286-1886
Practice Address - Street 1:28 W COLE RD # C
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9428
Practice Address - Country:US
Practice Address - Phone:207-286-2273
Practice Address - Fax:207-286-1886
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431575399Medicaid
MEAA98961OtherHARVARD PILGRIM
ME200251OtherANTHEM
MEAA98961OtherHARVARD PILGRIM
MEI24382Medicare UPIN