Healthcare Provider Details

I. General information

NPI: 1023009388
Provider Name (Legal Business Name): MATTHEW SCOTT MOLISON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-930-6708
  • Fax: 207-930-6709
Mailing address:
  • Phone: 207-930-6708
  • Fax: 207-930-6709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: