Provider Demographics
NPI:1457356990
Name:HANSON, R SCOTT (MD, MPH)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:SCOTT
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:RICHARD
Other - Middle Name:SCOTT
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15 CHALLENGER DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-1041
Mailing Address - Country:US
Mailing Address - Phone:207-753-4601
Mailing Address - Fax:
Practice Address - Street 1:15 CHALLENGER DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-1041
Practice Address - Country:US
Practice Address - Phone:207-753-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91860207R00000X
ME19920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
101844OtherMEDICARE A
FL21250921881OtherBEECHSTREET/CAPP CARE
FL271800600Medicaid
FLSG076504OtherVISTA
FL52159OtherBLUE CROSS BLUE SHIELD
FL02036OtherUNIVERSAL HEALTH CARE
FLP00169584OtherRR MEDICARE
FLP00169584OtherRR MEDICARE
52159ZMedicare ID - Type Unspecified
FL271800600Medicaid