Provider Demographics
NPI:1003910126
Name:STEIDL, SCOTT M (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:STEIDL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:53 SEWALL STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2625
Mailing Address - Country:US
Mailing Address - Phone:207-828-2020
Mailing Address - Fax:207-773-7034
Practice Address - Street 1:53 SEWALL STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2625
Practice Address - Country:US
Practice Address - Phone:207-828-2020
Practice Address - Fax:207-773-7034
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME017234207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432349099Medicaid
ME432349099Medicaid
MEF54585Medicare UPIN