Healthcare Provider Details

I. General information

NPI: 1881124626
Provider Name (Legal Business Name): KATHRYN ELLIOTT NAGEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

IV. Provider business mailing address

175 US ROUTE 1
SCARBOROUGH ME
04074-9048
US

V. Phone/Fax

Practice location:
  • Phone: 207-396-7700
  • Fax: 207-396-7701
Mailing address:
  • Phone: 207-396-7700
  • Fax: 207-396-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD29811
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD29811
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number1015315
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD29811
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD29811
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: