Provider Demographics
NPI:1770557316
Name:SHULMAN, SCOTT D (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:D
Last Name:SHULMAN
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 934
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0934
Mailing Address - Country:US
Mailing Address - Phone:207-907-3339
Mailing Address - Fax:207-907-1214
Practice Address - Street 1:358 BROADWAY
Practice Address - Street 2:SUITE 306
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3929
Practice Address - Country:US
Practice Address - Phone:207-907-3660
Practice Address - Fax:207-907-3661
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD172682084N0400X
MN57645208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098569OtherANTHEM BLUE SHIELD
ME1951774OtherCIGNA
ME7327731OtherAETNA
ME432392399Medicaid
ME098569OtherANTHEM BLUE SHIELD
MEME2312Medicare PIN