Healthcare Provider Details

I. General information

NPI: 1629956438
Provider Name (Legal Business Name): CHRISTIAN SCOTT CUMBACK BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 HOLMES RD.
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

154 HOLMES RD.
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-332-8930
  • Fax:
Mailing address:
  • Phone: 207-331-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC50262
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: