Provider Demographics
NPI:1831180835
Name:SCOTT, SAMUEL S (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:324 GANNETT DR
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3266
Mailing Address - Country:US
Mailing Address - Phone:207-773-9729
Mailing Address - Fax:207-774-6501
Practice Address - Street 1:33 SEWALL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2603
Practice Address - Country:US
Practice Address - Phone:207-828-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012497207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1831180835Medicaid
A60035OtherHPHC
0378600001OtherDMERC - CENTRAL MAINE ORT
NX3624OtherMEDICARE P-TAN #
P00063691OtherRAILROAD MEDICARE
1040611OtherAETNA
201017OtherCMO ASC FACILITY - MEDICA
ME119490000Medicaid
5523677OtherCIGNA
MM0716OtherCMO CLINIC FACILITY - MC
A60035Medicare UPIN
NX3624OtherMEDICARE P-TAN #