Healthcare Provider Details

I. General information

NPI: 1821043068
Provider Name (Legal Business Name): SCOTT CLOUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CORPORATE DR
BANGOR ME
04401-4312
US

IV. Provider business mailing address

43 WHITING HILL RD SUITE 300
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-1155
  • Fax: 207-945-5063
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number015251
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: