Healthcare Provider Details

I. General information

NPI: 1104846237
Provider Name (Legal Business Name): SCOTT H WALTON PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 BATH RD STE 102
BRUNSWICK ME
04011-2656
US

IV. Provider business mailing address

430 BATH RD STE 102
BRUNSWICK ME
04011-2656
US

V. Phone/Fax

Practice location:
  • Phone: 207-442-0350
  • Fax: 207-618-5668
Mailing address:
  • Phone: 207-442-0350
  • Fax: 207-618-5668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-845
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA845
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: